The technique of tracheal intubation is a basic expert skill that all anesthesiologists should have, as it is performed almost daily in the operating room. Although difficult intubation is relatively rare, it is a common cause of anesthesia-related morbidity and mortality when it does occur.¹ In order to minimize the possibility of intubation failure, it is imperative that anesthesiologists are able to deal successfully with unpredictable or predictable difficult intubations, often through the use of specifically designed devices or associated techniques of salient thought to overcome the difficulties. In this issue of Acta Anaesthesiologica Taiwanica, Umesh et al² compared the traditional jaw lift maneuver³ with a novel maneuver, tongue traction, for facilitating Trachlight (TL)-guided orotracheal intubation. The main objective of their well-designed study was to evaluate the usefulness of tongue traction, made possible by the padded artery forceps, compared to the jaw lift maneuver. The TL is a lighted stylet⁴ and its optimal use depends on correct transillumination (clear, bright glow) through the cricothyroid membrane;⁵ it takes advantage of the anterior location of the trachea relative to the esophagus. If the tip of the TL and the tracheal tube lies behind the tongue (in the glossoepiglottic fold) during intubation, successful intubation may be impossible. This situation may frequently occur when the TL is used alone. Umesh et al² overcame this problem by tongue traction with a padded artery forceps, which attained a 100% success rate. They concluded that tongue traction is as good as the jaw lift maneuver with regard to the success rate and time taken for TL-guided orotracheal intubation. In fact, there is another associated technique, i.e. direct laryngoscopy, that can facilitate successful TL-guided orotracheal intubation.⁴ However, tongue traction with a padded artery forceps is not only a practical alternative method to increase the success rate of intubation, but also a less traumatic complementary technique in managing unanticipated difficult intubation. In short, the more such devices can be used to solve the problem of difficult airway, the better the reduction in morbidity. When a difficult intubation is anticipated, the special equipment necessary should be prepared beforehand, and awake fiberscopic intubation is preferable. However, complementary devices and techniques may also be used as alternatives when difficult intubation is unpredictable. Wen-Jinn Liaw, MD, PhD Associate Editor, Acta Anaesthesiologica Taiwanica Associate Professor and Chairman, Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center