There are many scoring systems available to estimate the difficulty of securing the airway but none of them achieve 100% predictive value... In the case of expected difficulty, the only completely safe procedure is to keep the patient spontaneously ventilating during intubation, for example by using topical anesthesia and fibroscopy.

The real challenge is the unexpected difficult airway. In order to successfully manage this stressful situation there are few things you need to know: to call for help in time, to have alternative devices available (laryngeal mask airway, videolaryngoscope) and do not try to intubate at any cost, if you can ventilate with a simpler device (LMA, face mask). If these fail and if we are in a "CAN'T VENTILATE, CAN'T INTUBATE" situation, proceed to the coniotomy early rather than wasting time with multiple failed attempts at intubation.