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Background and objective: To describe the efficacy and safety of a flexible bronchoscopy intubation (FBI) protocol in patients with difficult airway. Method: We reviewed the medical records of patients diagnosed with difficult airway who underwent flexible bronchoscopy intubation under spontaneous ventilation and sedation with midazolam and fentanyl from March 2009 to December 2010. Results: The study enrolled 102 patients, 69 (67.7%) men and 33 (32.3%) women, with a mean age of 44 years. FBI was performed in 59 patients (57.8%) with expected difficult airway in the operating room, in 39 patients (38.2%) in the Intensive Care Unit (ICU), and in 4 patients (3.9%) in the emergency room. Cough, decrease in transient oxygen saturation, and difficult progression of the cannula through the larynx were the main complications, but these factors did not prevent intubation. Conclusion: FBI according to the conscious sedation protocol with midazolam and fentanyl is effective and safe in the management of patients with difficult airway. Keywords: Bronchoscopy, Airway Management, Intubation Intratracheal, Deep Sedation