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Updated: Aug 30, 2026
Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
Laryngeal mask airway for ventilation during diagnostic and interventional fibreoptic bronchoscopy in children
Vanda G Yazbeck-Karam1, Marie T Aouad, Anis S Baraka
1Clinique Dr Rizk, American University of Beirut Medical Center, Beirut, Lebanon.
Insights
The laryngeal mask airway (LMA) provides safe and effective ventilation for pediatric fiberoptic bronchoscopy. This method allows the use of larger bronchoscopes, improving airway management in children.
Area of Science:
- Pediatric Anesthesiology
- Respiratory Medicine
- Interventional Pulmonology
Background:
- Flexible fiberoptic bronchoscopy is increasingly used in pediatric interventional and diagnostic procedures.
- Traditional airway management techniques may pose challenges during pediatric bronchoscopy.
Purpose of the Study:
- To evaluate the efficacy and safety of using the laryngeal mask airway (LMA) for ventilation and anesthesia during fiberoptic bronchoscopy in children.
- To assess the feasibility of using an adult bronchoscope with an LMA in pediatric patients.
Main Methods:
- The technique was applied to 10 children aged 1.2-5 years undergoing fiberoptic bronchoscopy.
- Anesthesia was induced with sevoflurane, and a size 2 or 2.5 LMA was inserted.
- A flexible adult fiberoptic bronchoscope was passed through a swivel adapter connected to the LMA.
Main Results:
- Successful completion of fiberoptic bronchoscopy in all 10 pediatric patients.
- One case of laryngospasm, managed by deepening anesthesia.
- One instance of hypoxia and hypercarbia, resolved by bronchoscope withdrawal.
Conclusions:
- The laryngeal mask airway is a safe and effective adjunct for pediatric fiberoptic bronchoscopy under general anesthesia.
- The LMA's larger internal diameter facilitates the use of larger bronchoscopes with minimal increase in airway resistance.
Background:
The use of the flexible fibreoptic bronchoscope in infants and children has expanded to include both interventional and diagnostic bronchoscopy. The present report utilizes the laryngeal mask airway (LMATM) for ventilation and anaesthesia administration in children during fibreoptic bronchoscopy using an adult bronchoscope.
Methods:
The technique was used in 10 children; their age ranged between 1.2 and 5 years. Six of these children had a history of foreign body aspiration and underwent interventional bronchoscopy, while four children underwent diagnostic bronchoscopy. Anaesthesia was induced by facemask using sevoflurane 6-8% followed by the insertion of a LMA size 2 or 2.5. A swivel adapter connected the proximal end of the LMA to the T-piece anaesthesia system. Anaesthesia was then maintained with spontaneous breathing of sevoflurane 2-4% in oxygen, delivered via the LMA. A flexible adult fibreoptic bronchoscope (outer diameter 4.9 mm) was inserted via the swivel adapter.
Results:
The procedure could be accomplished successfully in the 10 patients. However, one child developed laryngospasm that was easily relieved by deepening the level of anaesthesia. In a second child hypoxia and hypercarbia occurred and were relieved by intermittent withdrawal of the fibreoptic bronchoscope.
Conclusions:
Laryngeal mask airway is a safe and effective adjunct to fibreoptic bronchoscopy under general anaesthesia in children. Its larger internal diameter compared with a tracheal tube permits the use of relatively large fibreoptic bronchoscope without a significant increase in airway resistance.
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