A fiberoptic orotracheal intubation successfully performed using a modified Guedel airway in a sedated emergency patient - A case report

Abstract

Background: Fiberoptic intubation is a powerful and safe technique to deal with airway difficulty, but it requires a lot of training to be able to perform correctly. There are various specialized oral airways for fiberoptic intubation, but none of them have perfect functionality.

Case: A 75-year-old male (body weight 71.6 kg, height 159.3 cm, body mass index 28.22 kg/m²) was diagnosed with acute appendicitis, and it was decided to do a laparoscopic appendectomy. After the induction of general anesthesia, it was impossible to insert the direct laryngoscope deep enough for vocal cord visualization without damaging the teeth because of limited mouth opening. We successfully performed fiberoptic intubation with a newly modified Guedel airway via a longitudinal channel on the convex side and a distal opened lingual end.

Conclusions: Our modified Guedel airway can be useful in assisting fiberoptic intubation in unexpectedly difficult airway situations.

Keywords: Airway management; Aneshthesi general; Deep sedation; Intratracheal; Intubation.

Fig. 1.

Photos of modified Guedel airway.

Fig. 2.

The fiberoptic intubation procedure with a modified Guedel airway (inset photo: laryngeal view of bronchoscope during the procedure).

Fig. 3.

The scheme of how the modified Guedel airway can be removed from the oral cavity (A: the modified Guedel airway with Lee style, B: our new design). (1): Fiberoptic bronchoscope. Each arrow: direction of oral airway removal. Thick line: opening of the airway for removal.

Fig. 4.

The 3D scanned images of modified Guedel airway: (A) Front view, (B) Bottom view, (C) The simulation of fiberoptic cable passage along the posterior channel, (D) The distal lingual opening for the flexion of fiberoptic tip, (E) The simulation of the removal of the modified Guedel airway from the fiberoptic cable through the posterior longitudinal channel.