Sedation and fiberoptic intubation of a neonate with a cystic hygroma

The flexible bronchoscope (FB) has been used to secure the difficult airway in pediatric patients ( 1). Difficult intubations in patients with cystic hygromas have been performed in awake patients or after the induction of general anesthesia ( 2). A recent case report acknowledges the challenges of performing intubations in pediatric patients under sedation because of their inability to fully cooperate ( 3). The following case demonstrates the two step - two fiberoptic bronchoscopic tracheal intubation performed using sedation and topical anesthesia in a neonate with a difficult airway.