To the Editor:—

An intubating airway is a useful aid in fiberoptic intubation. While recently preparing to perform an urgent awake oral fiberoptic intubation, a 10-cm Fig. 1. Side-by-side comparison of a normal Williams intubating airway ( left ) and the faulty one ( right ). Note a protruding plastic piece (“tooth”) in the circular lumen of the faulty airway, at approximately the 2 o’clock position. A second “tooth” was located at the 10 o’clock position and has been dislodged after passing an endotracheal tube. Williams Fiberoptic Intubating Airway (Anesthesia Associates, Inc., San Marcos, CA) was readied for insertion. At this time, it was noted that the airway was defective, with two plastic tooth-like spikes protruding inside the airway’s lumen, approximately 2 cm from the flange (fig. 1). Two additional airways from the same package were found to have identical defects. A fourth airway without such a defect was used, and fiberoptic endotracheal intubation was accomplished easily with it.

Inspection of the Williams airway before placement prevented the use of this defective device. Later, an attempt to pass a 7.5-mm endotracheal tube through this airway resulted in a large tear of the endotracheal cuff and dislodgment of one of the protruding plastic pieces. In a patient, this could have resulted in two potential problems: a leaking endotracheal cuff and a foreign object in the airway. All of the defective Williams airways that we found came in the same package and were from the same batch. A careful check of our remaining stock did not reveal additional defective airways. The plastic spikes appeared to have been formed during the manufacturing process, perhaps as a result of a defective mold. Because several of our Williams airways had this defect, it is possible that other practitioners may encounter such a manufacturing defect, and, therefore, we wanted to alert readers to this potential problem. We have also informed the manufacturer about this defect. This experience illustrates that even under emergency situations, it is important to check equipment for unexpected flaws that may endanger the patient.