Background Many extraglottic airway devices allow the direct passage of an adult-sized tracheal tube, but this is not possible with the LMA-SupremeTM. We evaluated the feasibility of using the LMA-SupremeTM as a conduit for intubation in patients with known difficult airways. Methods Sixty-eight adult patients, with preoperative predictors of difficult intubation, were scheduled for elective surgery under general anaesthesia. After assessing the direct laryngoscopy view, 23 patients with CormackLehane III/IV were included in the study. An LMA-SupremeTM was inserted, followed by the passage of a flexible bronchoscope loaded with an Aintree Intubation Catheter into the trachea. The bronchoscope and LMA-SupremeTM were removed, and a tracheal tube was railroaded over the Aintree Intubation Catheter into the trachea. Results Tracheal intubation was successful in all patients using the above technique. SpO2 was >95% during the intubation procedure. Conclusions We conclude that the LMA-SupremeTM is a successful conduit for bronchoscopic/Aintree Intubation Catheter-guided intubation in patients with known difficult airway.