Difficult Airway Algorithm

A 28-year-old male with a history of difficult intubation (Cormack–Lehane Grade 3 at last anesthesia) presents for elective laparoscopic cholecystectomy. During rapid sequence intubation under general anesthesia, after induction with propofol and succinylcholine, the anesthesiologist attempts direct laryngoscopy and obtains a Grade 3 view. A second attempt with a different blade angle yields Grade 2 view. After two failed intubation attempts, the patient's oxygen saturation drops to 88% despite bag-mask ventilation. Which is the MOST appropriate next step?

A 45-year-old male with a history of obstructive sleep apnea (OSA), BMI 38 kg/m², and hypertension is scheduled for elective laparoscopic cholecystectomy under general anesthesia. Preoperative airway assessment reveals Mallampati Grade III, limited neck extension, and a thyromental distance of 5 cm. After induction with propofol and succinylcholine, the anesthesiologist encounters difficulty with intubation. Bag-mask ventilation is adequate. After 3 failed intubation attempts, the patient's SpO₂ drops to 88%. Which of the following is the most appropriate next step?