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Table of Contents
LETTER TO EDITOR
Year : 2012  |  Volume : 28  |  Issue : 4  |  Page : 542-543

Modified Guedel's airway for facilitation of fiberoptic laryngoscopy


Department of Anaesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India

Date of Web Publication4-Oct-2012

Correspondence Address:
Anuj Jain
Department of Anaesthesiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9185.101961

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How to cite this article:
Rastogi A, Jain A, Singh S, Gyanesh P. Modified Guedel's airway for facilitation of fiberoptic laryngoscopy. J Anaesthesiol Clin Pharmacol 2012;28:542-3

How to cite this URL:
Rastogi A, Jain A, Singh S, Gyanesh P. Modified Guedel's airway for facilitation of fiberoptic laryngoscopy. J Anaesthesiol Clin Pharmacol [serial online] 2012 [cited 2019 Aug 18];28:542-3. Available from: http://www.joacp.org/text.asp?2012/28/4/542/101961

Sir,

Fiberoptic laryngoscopy (FOL) is an important armamentarium for managing difficult airway. FOL is used for intubating the trachea in awake patients or in patients under general anesthesia. Literature proves the usefulness of various oral airways in facilitation of endotracheal intubation (ETI) using FOL. [1],[2],[3] Oral airways aid in mask ventilation and directing the scope towards the glottis during FOL. During FOL in awake patients, these airways serve as the bite blocks while in FOL after induction of anesthesia these airways maintain the contour of the oropharynx. Several types of airway are available for this purpose namely William's airway, Berman's airway, Ovassapian's airway. Various modifications of the oral airways have been suggested from time to time. [4] We have modified the Guedel's airway to serve as FOL assist airway. In three simple steps, we can convert a conventional Guedel's airway to FOL assist airway.

Step 1: An appropriate size Guedel's airway is taken and an 8mm strip of the plastic is cut from the convex surface [Figure 1].
Figure 1: The posterior aspect of the modified Guedel's airway along with the bite block.

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Step 2: An 8mm strip of plastic is cut from the color coded bite block if a 5mm FOL is to be used [Figure 1].

Step 3: The bite block is inserted into the airway so that the cut surface of the airway and bite blocks is opposite to each other [Figure 2].
Figure 2: The method of insertion of the bite block into the Guedel's airway. The two cut surface are placed opposite to each other. This maneuver helps retain the scope in the airway

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This modified Guedel's airway is inserted just like a conventional Guedel's airway. The fiber-optic scope is inserted through the channel in the bite block and the scope is forwarded along the length of airway to visualize the glottis. Once the trachea has been entered, the airway has to be removed and the endotracheal tube rail-roaded in. While removing the airway over the scope the bite block has to be removed first followed by the airway.

We have used this airway in fifty patients, achieving almost hundred percent success rates. This modification of the airway is easily designed, cheap and disposable and due to the shape of the Guedel's airway the distal end directs the scope to the glottis. Users have to remember that choosing an inappropriate sized airway may make their task difficult instead of simplifying it. One limitation of this airway is that it cannot be inserted in patients with restricted mouth opening.

 
  References Top

1.Patil V, Stehling LC, Zauder HL, Koch JP. Mechanical aids for fiberoptic endoscopy. Anesthesiology 1982;57:69-70.  Back to cited text no. 1
    
2.Ovassapian A. Fiberoptic tracheal intubation in adults. In: Ovassapian A, editor.Fiberoptic Endoscopy and the Difficult Airway. 2nd ed.Philadelphia: Lippincott-Raven Publishers; 1996. p. 71- 103.  Back to cited text no. 2
    
3.Patil V, Stehling LC, Zauder HL. Fiberoptic endoscopy in anesthesia. Chicago: Year Book Publishers; 1983.  Back to cited text no. 3
    
4.Bameshki AR, Bakhshaee M. An airway which facilitates intubation with a fiberoptic laryngoscope. Iran J Otorhinolaryngol 2010;61:159-60.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2]



 

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