What is An Oropharyngeal Airway?

Understanding the Oropharyngeal Airway

An oropharyngeal airway (OPA) is a medical device used to maintain an open airway by preventing the tongue from obstructing the oropharynx. It is commonly used in emergency situations and medical settings to assist with ventilation in patients who are unconscious or experiencing airway obstruction.

The OPA is a curved, rigid device that is inserted into the mouth and positioned in the back of the throat to keep the airway clear. It is designed for short-term use and is most effective in patients who are unresponsive and do not have an intact gag reflex. As an airway adjunct, it plays a crucial role in relieving or bypassing upper airway obstructions, ensuring adequate ventilation and oxygenation, especially in emergency situations involving respiratory distress.

Definition and Purpose

An oropharyngeal airway (OPA) is a medical device designed to maintain airway patency and relieve upper airway obstruction in patients who are unconscious or have a reduced level of consciousness. The primary purpose of an OPA is to prevent the tongue from blocking the airway, ensuring adequate ventilation and oxygenation. This device is a crucial component of airway management, particularly in emergency situations where timely airway management is essential for successful cardiopulmonary resuscitation.

The OPA is typically used in conjunction with other airway management techniques, such as the head-tilt-chin lift and suctioning, to establish and maintain a patent airway. It is commonly used in both pediatric and adult patients, but its use is especially critical in pediatric patients due to their smaller airway size and increased susceptibility to pediatric airway problems.

Also known as an oral airway or Guedel pattern airway, named after its inventor Arthur Guedel, the OPA is a curved plastic or rubber device that matches the natural curvature of the mouth and throat. It features a flange at one end that remains outside the mouth to prevent the device from slipping further into the airway.

In cases where an OPA is not suitable, alternative methods such as nasopharyngeal airway insertion may be used to maintain airway patency. However, it is essential to choose the correct size of the OPA to ensure proper fit and function, as an improperly sized OPA can cause airway obstruction or trauma to the surrounding tissues.

Overall, the oropharyngeal airway is a vital tool in airway management, and its proper use is critical in preventing airway obstruction and ensuring adequate ventilation and oxygenation in patients who are unable to maintain their own airway.

When is an Oropharyngeal Airway Used?

An OPA is used in various medical situations, including:

• Emergency airway management – When a patient is unconscious and at risk of airway obstruction. Effective and timely airway management is critical to prevent the progression to cardiopulmonary arrest in patients experiencing acute respiratory failure.

• Cardiac arrest – To assist in maintaining an open airway during resuscitation efforts.

• Anesthesia and surgical procedures – To keep the airway clear while under sedation.

• Prevention of airway obstruction – In patients with altered consciousness due to trauma, overdose, or neurological conditions.

Medical professionals determine the need for an OPA based on the patient’s level of consciousness and the presence of a gag reflex.

How an Oropharyngeal Airway Works

The primary function of an OPA is to prevent airway blockage caused by the tongue falling back into the throat. It works by:

• Lifting the tongue – The curved shape of the OPA displaces the tongue, keeping the airway open.

• Providing a clear passage for ventilation – It allows for unobstructed airflow, which is crucial in resuscitation and mechanical ventilation.

• Reducing the risk of airway collapse – Especially in unconscious patients who lack muscle tone.

Proper placement is essential to ensure effectiveness and minimize complications.

Correct Sizing and Insertion of an Oropharyngeal Airway

Choosing the correct size OPA is critical for patient safety. The appropriate size is determined by measuring from the corner of the mouth to the angle of the jaw. Steps for insertion include:

• Positioning the patient with their head tilted slightly backward to open the airway.

• Inserting the OPA upside down initially, with the curve facing the roof of the mouth.

• Rotating the airway 180 degrees once it reaches the back of the throat, ensuring proper positioning.

• Confirming that the device sits securely without causing obstruction or discomfort.

Oropharyngeal airway insertion is a crucial skill in emergency care, as it helps prevent respiratory complications when patients cannot regulate their own airway. Proper insertion techniques, correct sizing, and awareness of potential complications are essential for maintaining a patent airway and effective resuscitation.

Improper sizing or placement can lead to complications, such as gagging, aspiration, or airway trauma.

Risks and Considerations in Airway Management

While an OPA is a valuable tool in airway management, there are risks and contraindications to consider:

• Not suitable for conscious patients – Inserting an OPA in a patient with an active gag reflex can cause vomiting and aspiration.

• Potential for airway trauma – Improper insertion may cause soft tissue damage or bleeding.

• Obstruction risk if misused – An incorrectly placed OPA can worsen airway obstruction rather than relieve it.

• Should not be used as a long-term airway solution – It is meant for temporary airway management until more definitive interventions are provided.

• Awareness of cervical spine injury – If a cervical spine injury is suspected, specific positioning maneuvers should be employed that avoid neck movement, ensuring the airway remains patent while minimizing further risk of injury.

Medical professionals should evaluate each patient’s condition before using an OPA and be trained in proper insertion techniques.

Alternatives to an Oropharyngeal Airway: Nasopharyngeal Airway

In cases where an OPA is not suitable, other airway management options include:

• Nasopharyngeal airway (NPA) – A flexible tube inserted through the nostril, suitable for semi-conscious patients.

• Endotracheal intubation – A more advanced airway procedure for prolonged ventilation support.

• Supraglottic airways – Devices such as laryngeal mask airways (LMA) used in anesthesia and emergency care.

The choice of airway device depends on the patient's condition and the level of airway obstruction.

Conclusion

An oropharyngeal airway is a crucial device used to maintain an open airway in unconscious patients at risk of obstruction. By keeping the tongue from blocking the airway, it ensures adequate airflow and supports ventilation during medical emergencies. Proper selection, sizing, and insertion are essential to avoid complications. While it is a valuable tool in emergency and surgical settings, it should be used appropriately and in conjunction with other airway management techniques when necessary.

FAQs

What is an oropharyngeal airway used for?

An oropharyngeal airway is used to keep the airway open in unconscious patients, preventing obstruction caused by the tongue. Oropharyngeal airways are particularly indicated for use in patients with severe airway obstructions. Proper insertion techniques and the necessary equipment are crucial to avoid potential complications associated with improper sizing. These airways play a critical role in emergency airway management and resuscitation scenarios.

How do you determine the correct size of an OPA?

The correct size is measured from the corner of the mouth to the angle of the jaw to ensure proper fit and effectiveness.

Can an oropharyngeal airway be used in conscious patients with an intact gag reflex?

No, it should only be used in unconscious patients without a gag reflex, as it can cause gagging and aspiration in conscious individuals.

What are the risks of using an OPA?

Potential risks include airway trauma, aspiration, discomfort, and improper placement leading to obstruction.

What are the alternatives to an oropharyngeal airway?

Alternatives include nasopharyngeal airways, endotracheal intubation, and supraglottic airways, depending on the patient's needs.