Anesth Pain Med.  2020 Jul;15(3):378-382. 10.17085/apm.20030.

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

  • 1Department of Anesthesiology and Pain Medicine, VHS Medical Center, Seoul, Korea


An airway assessment is usually best performed before an elective operation. But in an emergency operation, proper airway assessment can often be difficult. 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.
Our modified Guedel airway can be useful in assisting fiberoptic intubation in unexpectedly difficult airway situations.


Airway difficulty; Fiberoptic intubation; Oral airway
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