A novel technique for management of the difficult airway is described. The case report describes fibreoptic intubation of a patient who refused awake intubation. An endotracheal tube was advanced as far as the nasopharynx via the nostril of the patient, under anaesthesia. Connection of the anaesthetic circuit allowed maintenance of anaesthesia, oxygenation and assisted ventilation while flexible bronchoscopy was performed through the tube via a bronchoscopy connector. The endotracheal tube was subsequently advanced over the bronchoscope into the trachea. This technique uses readily available materials and can be used where the placement of a laryngeal mask is contraindicated or impossible.
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