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Updated: Aug 15, 2026

Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
Using a nasopharyngeal airway during fiberoptic intubation in small children with a difficult airway
Rolf Holm-Knudsen1, Kirsten Eriksen, Lars S Rasmussen
1Department of Anaesthesia and Operating Theatre Services, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej, Copenhagen, Denmark. rhk@rh.dk
Background:
Induction of anesthesia and tracheal intubation in small children with a difficult airway is a challenging task. We report the experience with a procedure based on sevoflurane inhalation via a nasopharyngeal airway inserted early during induction before airway obstruction occurs. A pediatric fiberscope is used to perform a nasotracheal intubation via the opposite nostril.
Methods:
All small children with suspected or known difficult airway needing tracheal intubation were scheduled for a fiberoptic intubation following the described protocol.
Results:
In 3 years, we performed 27 successful fiberoptic guided tracheal intubations in 19 children, median age 8.2 months (1.0-39.1 months) and median weight 7.6 kg (3.0-15.0 kg). The optimal depth for placement of the nasopharyngeal airway was found to be 8.0 cm (7.0-8.5 cm) from the nostril in the first year of life and 8.5 cm (8.0-10 cm) in the second year. Oxygenation was sufficient during the entire procedure in all cases except one child who had short-lasting laryngeal spasm caused by instillation of lidocaine during light anesthesia. The duration of fiberoptic intubation was significantly shorter when performed by an experienced anesthesiologist (55 s vs. 120 s), but there was no significant correlation between the duration of fiberoscopy and oxygen saturation during fiberoscopy or endtidal CO(2) after intubation.
Conclusion:
The combination of nasopharyngeal airway and fiberoptic guided tracheal intubation seems to be a reliable and safe procedure for managing the difficult airway in small children.
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