Oropharyngeal airways
An
oropharyngeal airway is a curved plastic tube with a flange on one end that
sits between the tongue and hard palate to relieve soft palate obstruction.
Oropharyngeal
airways are also known as Guedel airways. This name comes from the inventor of
the device, Arthur Guedel who was an American anaesthetist.
Oropharyngeal
airways should only be inserted in unconscious patients, as it is otherwise
poorly tolerated and may induce gagging and aspiration. In contrast,
nasopharyngeal airways are less likely to stimulate the gag reflex and may be
more appropriate for semi-conscious patients.
There are
a variety of sizes available for children and adults. It is important that the
correct size of oropharyngeal airway is used.
There is a risk of trauma to the teeth and palate when inserting an oropharyngeal airway.
Indications for Oropharyngeal Airway
Oropharyngeal
airways are indicated for unconscious patients in the setting of
1- Bag-valve-mask
ventilation .
2- Spontaneously breathing patients with soft tissue obstruction of the upper airway who are deeply obtunded and have no gag reflex .
Contraindications for Oropharyngeal Airway
Consciousness
or presence of a gag reflex
Relative
contraindications
Insertion
of an oropharyngeal airway may not be feasible in some settings, such as
Oral
trauma
Trismus
(restriction of mouth opening including spasm of muscles of mastication)
Nasopharyngeal airways may be used instead.
Complications of Oropharyngeal Airway
Airway
obstruction by an improperly sized or improperly inserted oropharyngeal airway
Gagging and the potential for vomiting and aspiration .
Sizing the airway
Choose the correct size by measuring the
oropharyngeal airway against a patient’s face. When the tip is placed at the
angle of the jaw the flange should align with the centre of the top teeth (i.e.
measure ‘hard to hard’).
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Step-by-Step
Description of Oropharyngeal Airway Procedure
1- As necessary, clear
the oropharynx of obstructing secretions, vomitus, or foreign material.
2- Determine the
appropriate size of the oropharyngeal airway. Hold the airway beside the
patient’s cheek with the flange at the corner of the mouth. The tip of an
appropriately sized airway should just reach the angle of the mandibular ramus.
3- Next, begin
inserting the airway into the mouth with the tip pointed to the roof of the
mouth (ie, concave up).
4- To avoid cutting the
lips, be careful not to pinch the lips between the teeth and the airway as you
insert the airway.
5- Rotate the airway
180 degrees as you advance it into the posterior oropharynx. This technique
prevents the airway from pushing the tongue backward during insertion and
further obstructing the airway.
6- When fully inserted,
the flange of the device should rest at the patient’s lips.
Alternatively,
use a tongue blade to depress the tongue as you insert the airway with the tip
pointed to the floor of the mouth (ie, concave down). Use of the tongue blade
prevents the airway from pushing the tongue backward during insertion.
Aftercare for Oropharyngeal Airway
Ventilate
the patient as appropriate.
Monitor
the patient and identify and remediate any impediments to proper ventilation
and oxygenation.
Secure
the oropharyngeal airway if it should remain in place (eg, during mechanical
ventilation after oral endotracheal intubation).
Warnings
and Common Errors for Oropharyngeal Airway
Use an
oropharyngeal airway only if the patient is unconscious or minimally responsive
because it may stimulate gagging, which poses a risk of aspiration.
Nasopharyngeal airways are preferred for obtunded patients with intact gag
reflexes.