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Updated: May 1, 2026
Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
Pediatric flexible fiberoptic bronchoscopy through the laryngeal mask airway
1Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Md, USA.
Insights
The laryngeal mask airway (LMA) is a safe and effective tool for pediatric flexible fiberoptic bronchoscopy (FOB). It allows airway evaluation during spontaneous breathing without intubation, enabling the use of larger scopes.
Area of Science:
- Pediatric Otolaryngology
- Respiratory Medicine
- Anesthesiology
Background:
- Flexible fiberoptic bronchoscopy (FOB) is crucial for diagnosing pediatric respiratory conditions.
- Airway management during FOB in children presents unique challenges.
- The laryngeal mask airway (LMA) is an alternative to endotracheal intubation or face masks for airway support.
Purpose of the Study:
- To evaluate the safety and effectiveness of using the laryngeal mask airway (LMA) as an adjunct during pediatric flexible fiberoptic bronchoscopy (FOB).
Main Methods:
- A retrospective case-series study was conducted.
- Reviewed charts of 17 pediatric patients (3 months to 18 years) undergoing FOB with LMA.
- Patients had spontaneous ventilation under general anesthesia.
Main Results:
- Fifteen of seventeen patients (88%) underwent successful FOB with LMA without complications.
- Two cases experienced LMA failure, one due to obstruction requiring intubation, and another due to placement issues.
- No unplanned endotracheal intubations were required in the successful cases.
- LMA facilitated airway evaluation in two patients with mandibular hypoplasia where direct laryngoscopy failed.
Conclusions:
- The laryngeal mask airway (LMA) is a safe and effective adjunct for pediatric flexible fiberoptic bronchoscopy (FOB).
- LMA enables airway assessment during spontaneous ventilation, avoiding endotracheal tubes or face masks.
- This technique allows the use of larger fiberoptic scopes compared to nasal or endotracheal tube-based FOB.
Objective:
To determine the usefulness and safety of the laryngeal mask airway (LMA) as an adjunct to pediatric flexible fiberoptic bronchoscopy (FOB).
Design:
A case-series retrospective study.
Setting:
Pediatric otolaryngology tertiary referral center, outpatient and inpatient operating suites.
Patients:
Retrospective review of charts of children who had FOB performed with the use of LMA by the pediatric otolaryngology service. The patients were ages 3 months to 18 years with respiratory symptoms requiring FOB for diagnosis.
Interventions:
Use of LMA to support airway during FOB with spontaneous ventilation with the patients under general anesthesia.
Main Outcome Measures:
Ability to perform airway evaluation with FOB and LMA; number and type of complications.
Results:
Seventeen patients, ages 3 months to 18 years (median age, 39 months) underwent FOB with use of LMA. In 2 patients use of LMA failed-1 from airway obstruction with LMA in place, which required intubation, and another who could not have LMA appropriately placed. Fifteen patients underwent uncomplicated FOB through the LMA. None of these 15 patients required unplanned endotracheal intubation. Two patients with mandibular hypoplasia required LMA use for airway evaluation when the glottis could not be visualized at direct laryngoscopy.
Conclusions:
The LMA is a safe and effective adjunct to pediatric FOB. Laryngeal mask airway use for FOB allows evaluation of the airway during spontaneous ventilation without an endotracheal tube or a face mask. Larger fiberoptic scopes can be used through the LMA compared with pediatric FOB performed through the nose or through an endotracheal tube.
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