Go Un Roh,1 Yun Jeong Chae,2 Young Bok Lee,3 Wikwang Wang,3 Chang Ik Choi,3 In Kyong Yi2 1Department of Anesthesiology and Pain Medicine, College of Medicine, CHA University, Bundang CHA General Hospital, Seongnam, South Korea; 2Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, South Korea; 3Department of Anesthesiology and Pain Medicine, Yonsei University, Wonju College of Medicine, Wonju, South Korea Purpose: Palpation during intubation could be used as an ancillary method of providing real-time information of the endotracheal tube (ETT) placement before manual ventilation. This study aimed to evaluate the ability to discriminate the ETT location using a modified real-time palpation method with a preloaded stylet during intubation. Patients and methods: The examiner performing the real-time palpation method placed three fingers on the lateral sides of the trachea between the sternal notch and the thyroid cartilage to determine if endotracheal intubation was successful. Endotracheal intubation was confirmed by auscultation and quantitative carbon dioxide waveform using capnography. Results: Eighty-eight patients were enrolled in this study. The discrimination accuracy of the real-time palpation method was 98.9% (95% CI: 93.8–99.8) for identifying the location of ETT between the trachea and esophagus. There was one false negative, reported as esophageal intubation rather than tracheal intubation. Conclusion: The real-time palpation method during intubation using an ETT with a preloaded stylet is an instantly applicable technique with good discrimination ability. The addition of real-time information through this palpation method to the conventional intubation process, especially in patients with poor vocal cord visualization, would be useful to facilitate the process of safe and careful endotracheal intubation. Keywords: airway management, endotracheal, esophageal, intubation, palpation