Airway management is an essential modality of emergency and surgical care in which maintenance of a patent and free airway is crucial for adequate ventilation and oxygenation. The most commonly used device in airway management is the Guedel airway, otherwise referred to as an oropharyngeal airway (OPA). To know more about this helpful equipment, read about what airway Guedels are, their purpose, types, usage, advantages, limitations, and best practices for their usage in healthcare settings.
A Little Jist About The Airway Guedels
The Guedel airway is a medical device used to keep or open a patient’s airway by preventing the tongue from obscuring the epiglottis, which would block airflow to the lungs. The device was named after its inventor, the American anesthesiologist Arthur Guedel. Guedel developed the Guedel airway during the 1930s. It is typically made of plastic, but there are older types manufactured from rubber.
It is curved and hollow, mirroring the anatomy of the oropharynx. Its sizes range from infants to adults. It consists of a flange that remains outside a patient’s mouth to prevent the device from slipping in, and a central channel allows both air and fluids to pass through.
What Purpose Does Airway Guedels Serve?
These are some of the critical roles that Guedel Airways plays in clinical practice:
Obstruction Prevention: A Guedel airway obstruction prevents the airway from obstruction. This occurs because the tongue falls back against the posterior pharyngeal wall in the unconscious or semi-conscious patient, mainly when he is in the supine position.
The central channel in the Guedel airway facilitates the suctioning of secretions without needing their removal; hence, it is ideal for vomiting or excessive salivation.
Guedel airway can also assist in bag-valve-mask ventilation by maintaining a patent airway, hence allowing for better delivery of oxygen or anesthetic gases.
Airway Management during Anesthesia: These have been the mainstays of anesthesia, providing an open airway while the patient is under sedation or paralysis.
Different Types of Airway Guedels
Guedel airways are designed in various sizes and models with consideration to individual patient needs. These are summarised below:
- Size Variations: Guedel airways are manufactured in several sizes and usually range from 000 for neonates to 6 for large adults. An appropriate size is vital since a too-large size may traumatize the airway, whereas a small size may lead to ineffective management of it. The size is usually measured from the corner of the patient’s mouth to the angle of the jaw.
- Single-use versus Reusable: These are Guedel airways that are single-use and others that can be reused. Single-use airways are often preferred in settings where infection control is an issue, such as in emergency medicine or the intensive care unit.
- Material: Although most modern Guedel airways are made of medical-grade plastic, older ones are either rubber or latex. Plastic airways are generally used because they are easily sterilised, more resistant to being bitten, and produce fewer allergic reactions.
How to Use an Airway Guedel?
The correct use of the Guedel airway is crucial in the prevention of many complications that may be associated with its use, as well as ensuring effective management of the airway. The following is a step-by-step approach:
- Sizing: Measure the patient’s airway from the corner of the mouth to the angle of the jaw to select the appropriate size. An appropriately sized airway will comfortably fit without traumatizing or obstructing the patient.
- Insertion Technique
Comatose patients: Insert Guedel airway upside down (concave surface up) until soft palate is contacted. Rotate the device 180 degrees into the proper position; this can prevent pushing the tongue further into the pharynx.
Pediatric patients: Do not use the rotation technique. Direct the airway with a tongue depressor over the back of the tongue in its normal position.
- Monitoring: The patient should be continuously monitored for patency of the airway, ventilation, and oxygenation status. Observe for obstruction of the airway as manifested by noises such as snoring or gurgling, and check proper placement.
- Suctioning if needed: Provide suctioning through the central channel if secretions are present to prevent aspiration of secretions and to clear the airway.
Removing these should be done gently when the patient starts regaining consciousness and a gag reflex is elicited to avoid vomiting or aspiration.
Advantages of Airway Guedels
There are several advantages related to the airway Guedel, making them very useful in both emergency and routine clinical practices:
- Simplicity and ease of use: These are simple to use even in emergencies, and a minimum amount of training is required for their effective deployment.
- Cost-Effectiveness: Guedel airways are relatively inexpensive compared to other airway devices, making them a cost-effective solution for airway management.
- Versatility: It is suitable for a wide range of patients, from neonates to adults, and it can be used in several settings, such as pre-hospital, emergency departments, operating rooms, and intensive care units.
- Facilitates Effective Ventilation: They help keep the airway patent, which in turn allows for more effective ventilation either manually or with the use of a ventilator.
Risks and Limitations in the Use of Airway Guedels
Although airway Guedels are considered safe and easy, there are, however, some limitations and risks noted:
- Risk of Oral Trauma: The improper insertion or use of an incorrectly sized airway may traumatize the oral cavity, teeth, and oropharynx.
- Stimulation of the Gag Reflex: The stimulation of the gag reflex, leading to coughing, vomiting, or aspiration, has been noted with the Guedel airway in those patients who are not profoundly unconscious.
- Partial obstruction: If the device is not correctly placed, it tends to push the tongue backward, resulting in partial or total obstruction of the airway.
- Biting and Damage: All conscious and semi-conscious patients can bite the airways, resulting in damage to the airway device or even dentition and gum injuries.
Conclusion
The use of Guedels airways presents a simple yet effective means of maintaining the patency of the airway for a variety of clinical conditions; thus, identification of their purpose, appropriate use, advantages, and limitations will enable appropriate decisions for improving outcomes in both emergency and routine care. Regular training and adherence to best practices are paramount in maximising efficacy and safety.
