Steps in the technique, in sequence. (A) Aintree intubating catheter (AIC) (Cook® Medical Inc., Bloomington, IN, USA) was dressed over a flexible fiber-optic bronchoscope (FOB), leaving the distal 4 cm free to allow for flexion and extension of the FOB. (B) The FOB with the AIC were passed between the grids of the laryngeal mask airway (LMA) and through the larynx and into the trachea. The FOB was then removed with the AIC left in place. (C) The LMA was removed while the position of the AIC was maintained. (D) We attempted to 'railroad' the endotracheal tube (ETT) over the AIC, but the length of the portion of the AIC that remained outside our patient after its insertion was shorter than the length of the ETT. We were therefore unable to slide the ETT down into the trachea while maintaining the position of the AIC. (E) The exchange catheter was inserted through the inner port of the AIC and advanced until resistance was felt. Note the relative lengths of the two catheters. (F) The AIC was removed while the position of the exchange catheter was maintained in the trachea. (G) An ETT was advanced over the exchange catheter and into the trachea. The exchange catheter was then removed, and proper positioning of the ETT was confirmed by end-tidal carbon dioxide (ETCO2) and via fiber-optic visualization. (H) Relative lengths of the ETT, AIC, and exchange catheter when viewed together. The diameter of the exchange catheter is such that it can easily pass through the inner port of the AIC.