"Look-alike" Guedel oropharyngeal airway.

Dear Editor,

The most common oropharyngeal airway (OPA) used world-wide is Guedel airway. The Guedel airway used is color-coded for the size, according to the manufacturer/International Standard Organization (ISO). The oropharyngeal airway size is chosen according to the patient’s facial features. The flange should be approximated where it is abutting the lips and the tip should be able to reach the angle of the mandible.[1]

Recently we were informed about the two sizes of Guedel airway with the same color coding. Guedel airway of 100 mm (size 3) was color-coded as yellow and continued to carry the same color [Figure 1a]. The same manufacturer’s Guedel airway 90 mm (size 2) which was color-coded as green has been changed to yellow [Figure 1b]. The difference is in the two different batches of Guedel airways size 2 and size 3 manufactured by the same company (Romsons scientific and surgical industries private limited, Agra, Uttar Pradesh, India).

Figure 1

(a) Guedel airway size 2 (90 mm) and size 3 (100 mm) both are color-coded as yellow (look-alike) (b) Two Guedel airway of size 2 (90 mm) has two different color codings: yellow and green. All four Guedel airways are displayed with manufacturing details (same manufacturer) and the scale for the measurement of their length

The color coding of Guedel airway is for easy and quick identification of sizes. Incorrect size of OPAs might result in complications, especially in emergency care.[2] Our team has avoided complications as we were informed about 1) the same color coding (yellow) for two different sizes (size 2 and 3) [Figure 1a], 2) two different color coding (yellow and green) for same size 2 [Figure 1b]. In such situations, even an experienced anesthesiologist can make an inadvertent error as the size 2 and 3 look-alike by the color yellow. The aim of this article is to emphasis eternal vigilance and to create awareness among anesthesiologists that such manufacturing variations in size and color coding of OPAs might result in adverse clinical effect. Inappropriately sized OPAs may lead to complications like airway obstruction (if it is too small) and laryngospasm (if it is too large).[3] Even in the presence of color coding, choosing OPAs according to the size of the patient’s facial features would result in safe management.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.