The Shikani Optical StyletTM or SOS (Clarus Medical, USA) was developed as an aid to intubation for difficult airways.(1) The SOS is composed of a J-shaped malleable body and a lens and light source at the tip and an eyepiece at the proximal end. It combines the features of a fiberoptic bronchoscope and a lightwand. It can be used alone or combined with a camera or monitor and both adult and pediatric versions are available.(2,3) Although approved by the FDA in 1996, the SOS is still unknown to many anesthesiologists and has only a few user reports. In 2005, JIA Nan-guang developed the left molar approach to use the SOS. We have used the SOS with the left molar approach in over 15 000 cases without any major complications. This study was undertaken to compare hemodynamic changes after intubation using our technique and direct laryngoscopy in patients without difficult airway.