The introduction into clinical practice of new tools for intubation as videolaringoscopia has dramatically improved the success rate of intubation and the work of anesthesiologists in what is considered the most delicate maneuver. Nevertheless intubation difficulties may also be encountered with good anatomical visualization of glottic structures in videolaringoscopia. To overcome the obstacles that may occur both in a difficult provided intubation such as those unexpected, associated endotracheal introducer able to facilitate the passage of the endotracheal tube through the vocal cords into the trachea may be useful. We report 4 cases of difficult intubation planned and unplanned and completed successfully using the GlideScope videolaryngoscope associated with endotracheal Frova introducer. 1. Introduction Difficult airway management is a major task for anesthesiologists [1, 2]. Failure in airway management indeed, is a major cause of mortality and morbidity in the setting of anesthesiology and intensive care units [3, 4]. The GlideScope (GS) is a videolaryngoscope (VLS), the last generation of intubation devices available in clinical practice in the last decade. GS provides an indirect airway view, improves the assessment of Cormack-Lehane score, and does not require a specific training [5, 6]. Recent studies underline the advantages of VLS in the management of predicted difficult airway [7, 8] as well as prehospital emergencies [9]. Unfortunately, the direct laryngeal view provided by VLS does not always assure the correct insertion of endotracheal tube (ETT), due to the 60-degree angle in the distal portion of GS blade, that tends to hamper the passage of the ETT from oropharynx to trachea. To facilitate the placement of the ETT, a rigid stylet shaped with the same angle as the blade, the GlideRite stylet (GRs), has been made up. Recently, the most suitable characteristics of the introducer have been largely debated: gum elastic bougie, rigid stylet, malleable stylet, and several experiences have been published with different endotracheal introducer utilized in combination with VLS to facilitate intubation maneuver [10–14]. We report our clinical experience in 4 patients, three characterized by potential and one by unexpected difficult intubation, in whom videolaryngo-GlideScope (VLGS) combined with Frova bougie has been used to facilitate endotracheal intubation. 2. Case？？1 A 61-year-old woman (BMI: 22.6？kg/m2) was urgently admitted to the anesthesiological evaluation before undergoing the intervention of spinal decompression of cervical C3–C6
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