We performed the current study to compare general anesthesia (GA) and the non-asleep (NA) technique for fiberoptic tracheal intubation (TI) in pediatric patients with anticipated difficult airway. Patients in GA group (n= 20) were intubated using the fiberoptic broncoscope after induction of general anesthesia using inhalation of sevoflurane 3-5%. Patients in the NA group (n= 20) had sedation using ketamine and midazolam with the maximum of (2 and 0.01 mg/ kg) respectively and airway topicalization using lidocaine 2% via the “spray as you go” technique. We compared the techniques for time spent in induction, fiberscopy, and intubation, hemodynamic and ventilatory changes, success, complications, and grading of overall intubating conditions. We found that NA technique took longer intubation time (634.06 ± 43.107) compared to (119.02 ± 17.482) in GA group, less success rate being 60% compared to 95% in GA group and a higher incidence of complications. We conclude from this study that fiberoptic intubation in the pediatric difficult airway is more successful using the GA. However NA technique can be successful in the age group of 12- 36 months.