Had a patient a couple day's ago with HX of alcholism and esophogial varices. Predicted difficult intubation. esophogial varices is a contraindiction for a combitube for my back up plan for establishing an airway. Airway was a grade 3 to 4 , used the bougie was able to get the tube first try, bougie's are inexpensive and can definataly aid you in a difficult situation. For nasal intubations I also use the ET tubes that have the ring with a cord attached to the distal end that allows you to move the distal end anteriorally when you pull the ring these also help when nasally intubating.