As opposed to the simplistic promotion of one given technique or device, the multimodal airway management relies on the recognition that each individual approach may fail, that the maintenance of oxygenation during the procedure is a key point, that the prerequisites to the practical step of placing a tube in the trachea involve the knowledge of intelligent and intelligible algorithms and the previous acquisition of skills, with understanding of their foundations. An example of the ‘combination techniques’ using the specific advantages of one medical device to mitigate the limitations of another is the use of a videolaryngoscope to facilitate intubation with a flexible optical bronchoscope, which increases the ease and the success of the process during the clinical as well as the training phases. Other multimodal approaches such as the combination of bronchoscopy with the use of a supraglottic airway or with high flow nasal oxygen optimise the safety of the procedure by maintaining the delivery of oxygen. The multimodal approach is particularly useful for the anaesthesiologist and intensivist only occasionally exposed to the management of difficult airway situations. It improves high quality care of patients, education and training.

The flexible optical bronchoscope has unparalleled utility for difficult airway management and is part of every difficult airway management algorithm. The device can facilitate intubation for patients with airway tumours and bony or soft tissue abnormalities. It provides continuous visualisation of the airway during management, can be used to deliver local anaesthetics to the airway and is relatively less traumatic compared to other devices. Mastery of the device requires significant practice and the practitioner must use the device regularly to maintain skills. Several tips for success and pitfalls to be avoided are discussed.