Background: Foreign body (FB) aspiration is a typical emergency experienced by young children and associated with significant morbidity and mortality unless diagnosed early and treated adequately. Data on anesthetic management, applicability, complications and risk factors in the context of foreign body removal (FBR) is scarce, especially for flexible techniques, which are increasingly being used. Aim: To analyze the complication rate and risk factors as well as the anesthetic management of two different techniques (rigid versus flexible) for FBR in children. Method: This is a retrospective single center analysis of 160 cases who underwent bronchoscopy for suspected FB aspiration under general anesthesia between January 2014 and January 2022 at a tertiary hospital. Results: An FB was detected in 67 patients (median age 1.8 years). The preferred anesthesia regimes were total intravenous anesthesia (91.9%) and laryngeal mask (95%) for flexible bronchoscopy. Flexible bronchoscopy was used in 52.2%, rigid bronchoscopy in 31.3%, and both techniques were used in 16.4% of cases. The complication rate was 2.19 vs. 1.29/patient in rigid vs. flexible bronchoscopy, respectively. Independent risk factors for severe complications were rigid bronchoscopy (OR 11.6, p<0.01) and airway infections (OR 4.1, p<0.01). We observed flexible bronchoscopy being increasingly used for FBR during the observational period. Conclusion: FBR can result in serious complications that require experienced pediatric anesthetic management. In our series, the use of a rigid bronchoscope and preexisting airway infection were independent risk factors for severe complications. Flexible bronchoscopy was shown to be a safe, fast and successful tool for FBR with fewer adverse events compared to rigid bronchoscopy. Total intravenous anesthesia and a laryngeal mask airway for FBR are feasible and safe.