title: Airway obstruction associated with the use of the Guedel airway.
abstract: Soft tissue lateral neck radiography was used in 22 male patients older than 60 yr, to determine the cause of pharyngeal airway obstruction during anaesthesia, before and after insertion of a Guedel airway. In six of the patients, the airway was radiologically and clinically clear with the head in the neutral position. Nine patients showed obstruction of the airway by a "shelf" of tongue, but seven were cleared clinically by dorsiflexion at the atlanto-occipital joint, and the remaining two by the Esmarch-Heiberg manoeuvre. In four of the 22 patients, the Guedel airway was lodged in the vallecula in the neutral position. This was cleared clinically by dorsiflexion at the atlanto-occipital joint in all these patients. In three patients the Guedel airway was obstructed by the epiglottis, but this was cleared by dorsiflexion at the atlanto-occipital joint in two; in the third patient, the Guedel airway slipped into the vallecula after dorsiflexion at the atlanto-occipital joint and remained there despite the Esmarch-Heiberg manoeuvre. There was only one instance in 66 trials of a clinically obstructed airway without an apparent radiological cause. However, there were 10 instances in 66 trials of a clinically clear airway with an apparent radiological cause for obstruction.
authors.affiliation: Division of Anaesthesia, Northwick Park Hospital, Harrow, Middlesex.
authors.forename: A M
authors.initials: AM
authors.lastname: Marsh
authors.forename: J F
authors.initials: JF
authors.lastname: Nunn
authors.forename: S J
authors.initials: SJ
authors.lastname: Taylor
authors.forename: C H
authors.initials: CH
authors.lastname: Charlesworth
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000402:Airway Obstruction / Q000000981:diagnostic imaging / Q000209:etiology*; D000769:Anesthesia, Inhalation / Q000295:instrumentation; D006257:Head / Q000502:physiology; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology*; D007440:Intubation / Q000009:adverse effects / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000502:physiology; D010608:Pharyngeal Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D010614:Pharynx / Q000000981:diagnostic imaging; D011187:Posture; D011859:Radiography