Patients in whom the vocal cord visualisation starts with the retromolar method, which has been randomized determined preoperatively.

The second visualization then will be performed with the conventional method.

Patients in whom the vocal cord visualisation starts with the conventional method, which has been randomized determined preoperatively.

The second visualization then will be performed with the retromolar method.

For easier insertion of the laryngoscope the head of the patient will be turned to the left site. Thereafter the blade (Miller) will be inserted into the mouth and pushed carefully as far as possible laterally to receive a direct view of the vocal cords. Then the performing anesthesiologist determine the Cormack & Lehane score without and thereafter with a BURP (backward upward rightward pressure) maneuver.

In our present clinical trial we intend to compare the vocal cord visualisation by using the retromolar access compared to conventional intubation technique.

Visualisation will be performed by randomized sequence and both methods will be performed in each patient. When no 100% visualisation of the vocal cords is achievable, a BURP (backward upward rightward pressure) manoeuvre will be performed.

The same procedure will be performed for the another technique as well. For each trial, the anaesthesist has max. 30 seconds time for the vocal cord visualisation and scoring, which includes also the performance of the BURP-manoeuvre. Thereafter, and between each of the vocal cord visualizations as well, the patient will be ventilated by 100% oxygen for at least 20 seconds to reach at least 97% SpO2.

Then intubation is performed in all patients by the conventional methode, and if intubation fails the retromolar technique, if possible.