In patient who are predicted to be difficult to intubate with a standard direct laryngoscope well use flexible optical intubation via a supraglottic airway devise (the Ambu Aura-i). Patients are randomly assigner to a single- or a multiple- use flexible optical scope.

We hypothesize that intubation is obtained equally effective with both types of flexible scopes

Inclusion Criteria:

• ASA physical status 1-3 and evaluated pre-operatively and found suitable for tracheal intubation with a flexible optical scope via the SAD and scheduled for elective surgery/anesthesia and are conscious about their rights and consequences of participating in the study.

• The patient must have one or two of the following predictors of difficult tracheal intubation:

  1. Modified Mallampati score > 2 (= "no parts of the Uvula is visible")
  2. a thyromental distance of less then or equal to 6.5 cms
  3. Combined movement in head and neck < 90 degrees
  4. Mouth-opening less the 4 cm (but must be larger then 2.5 cm)
  5. Inability to protrude the teeth n the lower jaw beyond the upper incisors
  6. BMI > 40 combined with a neck-circumference > 43 cms
  7. Upper-lip-bite-test > 2
  8. Previous difficult intubation or laryngoscopy (If more then two criteria are fulfilled the patient should be considered intubated awake instead. . But the upper-lip-bite-test and the prognation-beyond the incisors test represents a similar thing, namely the inability to sub-luxate the lower jaw, the if both these findings are positive it is only considered as counting for one.

Exclusion Criteria:

• ASA physical status 4 or 5
• contraindications for use of the SAD
• Patients in whom intubation via a SAD has previously failed
• Patients at risk of aspiration from the gastrointestinal channel
• diseases in mouth, pharynx or larynx that precludes the use of a SAD
• Patients in whom the cricothyroid membrane cannot be localized preanaesthetically
• Patients in whom the doctor making the pre-anaesthetic evaluation finds in need of an awake intubation
• Patients with possible Creutzfeldt-Jacobs disease or contraindication against the use of non-autoclavable equipment r risk of cross contamination with prions