Our case report highlights the need for vigilance even when following international set protocols. While using a bougie, care must be taken to measure out the length of the bougie required for insertion. Eliciting the “hold up” sign for insertion should be abandoned. A difficult airway cart must have bougies of different sizes available to suit all age groups. Difficult intubation requiring intermediate-sized tubes will require other adjuncts till bougies of such sizes may be manufactured. Finally, a high index of suspicion must be kept toward aberrant perioperative behavior for prompt diagnosis and treatment of complications.