Related Experiment Video
Updated: Nov 13, 2025
Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
Single-Centre Open-Label Comparative Trial of Video-Assisted Fibreoptic-Bronchoscope-Guided Oral Versus Nasal
Kirti Sharma1, Usha Ganapathy1, Anju Gupta2
1Department of Anaesthesiology and Critical Care, VMMC and Safdarjung Hospital, Delhi, India.
Insights
Nasal flexible fibreoptic intubation is faster and easier than oral intubation in children aged 6-12 years. This study found the nasal route significantly reduced intubation time and improved success rates for paediatric patients.
Area of Science:
- Anesthesiology
- Pediatric Critical Care
- Airway Management
Background:
- Flexible fibreoptic intubation is a critical skill in pediatric anesthesia.
- Challenges exist in pediatric airway management, necessitating efficient intubation techniques.
- Limited comparative data exists for oral versus nasal flexible fibreoptic intubation in children.
Purpose of the Study:
- To compare the efficacy of nasal versus oral flexible fibreoptic tracheal intubation in pediatric patients.
- To determine if the nasal route offers a faster intubation time compared to the oral route.
- To evaluate success rates and complications associated with each intubation method.
Main Methods:
- Sixty children (6-12 years) were randomized to oral (FOI) or nasal (FNI) flexible fibreoptic intubation.
- Key metrics included time to glottic view, total intubation time, and success rates.
- Complications, need for external maneuvers, and ease of intubation were also assessed.
Main Results:
- Nasal intubation (FNI) demonstrated significantly shorter times to glottic view and total intubation compared to oral (FOI).
- Overall success rates were high (100% FNI vs. 96.6% FOI).
- Hemodynamic changes and subjective ease of intubation were comparable; complications were minor.
Conclusions:
- Nasal flexible fibreoptic intubation is superior to the oral route in children aged 6-12 years regarding speed and ease.
- The nasal approach should be considered the preferred method for fiberoptic-guided tracheal intubation in this pediatric population.
- This technique offers a safe and effective airway management strategy for children.
Objective:
Flexible fibreoptic intubation is challenging in paediatric patients. Very few studies have compared fibreoptic intubation via oral and nasal routes in children. We hypothesised that the total time to a successful fibreoptic-guided tracheal intubation would be faster through the nasal route when compared to the oral route.
Methods:
Sixty children aged 6-12 years were randomised to receive fibreoptic tracheal intubation through oral (group FOI) or nasal route (group FNI). We measured the time to glottic view and total time to successful tracheal intubation. The number of attempts needed, first attempt and overall success rate, external manoeuvres needed to obtain an adequate laryngeal view, subjective assessment of ease of intubation and complications, if any, were also recorded.
Results:
The time to glottic view (76.26±.7 s vs. 46.33±16.9 s; p=0.001) and total intubation time (4.55±1.07 min vs. 3.05±0.60 min; p<0.0001) were significantly higher in the FOI group as compared to the FNI group. An overall success rate was 100% in the FNI group and 96.6% in the FOI group. The haemodynamic parameters (mean heart rate and blood pressures) changes were comparable in the two groups at all time intervals. The subjective assessment of ease of intubation was comparable in the two groups (p=0.21). Complications were minor and self-limiting.
Conclusion:
Intubation guided by a nasal flexible fibreoptic bronchoscope is easier and faster when compared to oral intubation in children aged 6-12 years with normal airway, and it should be preferred for intubation in children requiring fibreoptic intubation.
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