- Intubation, Rescue Devices, and Airway Adjuncts. Oropharyngeal (OP) and nasopharyngeal (NP) airways can be used to maintain airway patency, particularly during BVM ventilation, but provide no airway protection.
- Airway Management. Oropharyngeal airway devices should be available in the full range of sizes at each anesthetizing location.
- Airway Management. Oropharyngeal airways displace the base of the tongue from the posterior pharyngeal wall and break contact between the tongue and palate (see Figure 119-2 ).
- Pediatric Equipment. Patrick A. Ross, ... Oropharyngeal airways are hard, non-latex plastic that are preformed in different sizes from 40 mm (infant) to 100 mm (large adult).
- Nonintubation Management of the Airway. Eric C. Matten, ... An oropharyngeal airway (OPA) is the most commonly used device to provide a patent upper airway.
- Pediatric Anesthesia Equipment and Monitoring. Ronald S. Litman, ... The cuffed oropharyngeal airway (COPA) is essentially a Guedel airway manufactured with a 15-mm anesthesia breathing circuit connector on the proximal ...
- Assessment, Methodology, Training, and Policies of Sleep. The oropharyngeal airway is divided into three segments: nasopharynx, oropharynx, and hypopharynx. ...
- The Unconscious Patient
- Pediatric Emergencies. Steven W. Salyer PA‐C, ... It is extremely important to use properly sized equipment in pediatric airway management.
- Teaching Airway Management Outside the Operating Room
When should an oropharyngeal airway be used in an obtunded patient?
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. NOTE: This is the Professional Version.
What is a contraindication for an oropharyngeal airway?
Contraindications Using an oropharyngeal airway on a conscious patient with an intact gag reflex is contraindicated. Patients that can cough still have a gag reflex and an OPA should not be used. If the patient has a foreign body obstructing the airway, an OPA should also not be used.
How to insert an oropharyngeal airway?
How to Insert an Oropharyngeal Airway Select the correct size by placing it against the patient´s face, it should extend from the centre of the lips to the angle of the jaw, alternatively, the angle of the lips to the lobe of the ear can also be used to size an OP airway.
What is the role of oropharyngeal airway in tracheostomy?
An oropharyngeal airway used concurrently with a nasopharyngeal airway may improve oxygenation and ventilation. Position the patient supine on the stretcher. Align the upper airway for optimal air passage by placing the patient into a proper sniffing position. Proper sniffing position aligns the external auditory canal with the sternal notch.
What are oropharyngeal airways are used for?
An oropharyngeal airway (oral airway, OPA) is an airway adjunct used to maintain or open the airway by stopping the tongue from covering the epiglottis. In this position, the tongue may prevent an individual from breathing.
What type of patient requires oropharyngeal airway?
Oropharyngeal airways are indicated only in unconscious people, because of the likelihood that the device would stimulate a gag reflex in conscious or semi-conscious persons. This could result in vomit and potentially lead to an obstructed airway.
When would you use an oral or nasal airway?
Oral and Nasal Airway Devices. Oral and nasal pharyngeal airway devices are used in pediatric anesthesia to improve the patency of the upper airway and to facilitate delivery of oxygen or anesthetic gases to the lungs. Minimum requirements for these devices are noted in ANSI/ISO5364-08 (ANSI/ISO 2008).
What are the 2 types of oropharyngeal airways?
Oropharyngeal (OP) and nasopharyngeal (NP) airways can be used to maintain airway patency, particularly during BVM ventilation, but provide no airway protection. In general, a patient who requires a device to maintain airway patency may also require intubation for airway protection.
Which is a contraindication to the use of an oropharyngeal airway?
Contraindications. Using an oropharyngeal airway on a conscious patient with an intact gag reflex is contraindicated. Patients that can cough still have a gag reflex and an OPA should not be used. If the patient has a foreign body obstructing the airway, an OPA should also not be used.
Which is a contraindication to the use of an oropharyngeal airway quizlet?
An oral airway is contraindicated in the awake or lightlyanesthetized patient-the patient may cough or develop laryngospasm during airway insertion iflaryngeal reflexes are intact.
How do you choose an oropharyngeal airway?
Select the proper size airway by measuring from the tip of the patient's earlobe to the tip of the patient's nose. The diameter of the airway should be the largest that will fit. To determine this, select the size that approximates the diameter of the patient's little finger.
In which of the following patients would a nasopharyngeal airway be contraindicated?
Rationale: Nasopharyngeal (nasal) airways are contraindicated in patients with severe head or facial injuries and should be used with caution in patients who have delicate nasal membranes or are prone to nosebleeds. The nasal airway is better tolerated in patients who are semiconscious and/or those with a gag reflex.
Which of the following is a disadvantage of oropharyngeal airways?
Which of the following is a disadvantage of oropharyngeal airways? They cannot be used in a patient with a gag reflex.
Which patients can nasopharyngeal airways be used?
Nasopharyngeal airways can be used in some settings where oropharyngeal airways cannot, eg, oral trauma or trismus (restriction of mouth opening including spasm of muscles of mastication). Nasopharyngeal airways may also help facilitate bag-valve-mask ventilation.
Which patients can nasopharyngeal airways be used?
Nasopharyngeal airways can be used in some settings where oropharyngeal airways cannot, eg, oral trauma or trismus (restriction of mouth opening including spasm of muscles of mastication). Nasopharyngeal airways may also help facilitate bag-valve-mask ventilation.
In which of the following patients would a nasopharyngeal airway be contraindicated?
Rationale: Nasopharyngeal (nasal) airways are contraindicated in patients with severe head or facial injuries and should be used with caution in patients who have delicate nasal membranes or are prone to nosebleeds. The nasal airway is better tolerated in patients who are semiconscious and/or those with a gag reflex.
When do you insert an oropharyngeal airway in an infant?
Open mouth using crossed- finger technique or tongue-jaw lift. Insert airway halfway, with curved end facing roof of mouth; then rotate airway 180° into position. Determine unresponsiveness, then measure distance of insertion (earlobe to corner of mouth). Select correct size of airway.
How do you choose an oropharyngeal airway?
Since oropharyngeal airways come in different sizes, it is important to pick the correct size for the victim. You can get a rough sense of the correct size by placing the airway at the side of the person's face and visualize how it will extend into the pharynx.
What are the two types of airway adjuncts?
There are two types of airway adjuncts. One is an oropharyngeal airway, and the other is a nasopharyngeal airway. This article will summarize the former.
What causes upper airway obstruction?
Upper airway obstruction may occur from anatomical causes such as choanal atresia, pathological causes such as a tonsillar abscess or adverse effects from patient management such as loss of airway patency during the administration of sedation and/or analgesia. [4][5]
How to open mouth with a tongue depressor?
Then, using a tongue depressor, push down on the tongue and, with the tip pointed caudally, insert the oropharyngeal airway directly into the mouth over the tongue. Technique 2: First, open the mouth.
Why do we need airway adjuncts?
Airway adjuncts are used to relieve or bypass an upper airway obstruction during airway management. However, upper airway obstruction may be present for several reasons, and airway adjuncts may not be able to relieve or bypass all types of obstruction. Upper airway obstruction may occur from anatomical causes such as choanal atresia, pathological causes such as a tonsillar abscess or adverse effects from patient management such as loss of airway patency during the administration of sedation and/or analgesia. [4][5]
What causes acute respiratory failure?
Acute respiratory failure is caused by a wide range of etiologies. Progression to cardiopulmonary arrest and ultimately death is likely in the absence of effective and timely airway management.
What are the parts of an oropharyngeal airway?
Preparation. An oropharyngeal airway has four parts: the flange, the body, the tip, and a channel to allow for passage of air and suction. Oropharyngeal airways come in a wide range of sizes (e.g., 40 mm to 110 mm). Choosing an appropriate oropharyngeal size is determined on an individual basis through the use of anatomical landmarks.
What is an airway positioning maneuver?
Airway positioning maneuvers place the airway in a neutral position and help move the tongue and palatal tissues away from the posterior wall of the pharynx. When choosing an airway positioning maneuver, one must be cognizant of the possible presence or absence of a cervical spine injury.
What is the OPA in medical terms?
An oropharyngeal airway (OPA) is also known as an oral airway or Guedel pattern airway or simply Guedel airway (named after the original designer Arthur Guedel). 2 The nasopharyngeal airway (NPA) is also called a nasal airway, NPAT (nasopharyngeal airway tube), or nasal trumpet. Either device can be used depending on the indications for use and patient circumstances.
Why do we need nasopharyngeal airways?
Nasopharyngeal airways are also used to keep the airway open and can be used with patients who are conscious or semi-conscious. For example, semi-conscious patients may need an NPA because they are at risk for airway obstruction but cannot have an OPA placed due to an intact gag reflex. Polyvinyl chloride nasopharyngeal airway tubes (NPATs) are readily available and are commonly used by anesthesia providers for patients either during induction or in the immediate postoperative period to help prevent obstruction of the airway. 8 NPAs may also work well for patients who are clenching their jaw, which makes inserting an oral airway difficult, and for those who are semi-conscious and need frequent nasal-tracheal suctioning.
What happens if an OPA is too small?
Although airways are simple to use, it is important to select an appropriate size. If the airway is too small, its distal end will be obstructed by the tongue, resulting in inadequate ventilation. 3 Radiographic assessment of the position of OPAs also demonstrated that the distal end of the airway may lodge in the vallecula or can be obstructed by the epiglottis. 5 If the OPA is too large, there is a risk of traumatic injury to the surrounding laryngeal structures 3, and possibly laryngospasm. 5
How to avoid trauma to the tongue?
Avoid forcing an oropharyngeal airway, which can lead to trauma to the lips and tongue. Use caution when twisting the oropharyngeal 180 degrees to avoid trauma along the hard palate. Use a water-soluble lubricant when inserting a nasopharyngeal airway.
Why do you need an OPA?
As described, the main indication for use of an OPA is if a patient is at risk of airway obstruction due to relaxed upper airway muscles or blockage of the airway by the tongue. For example, if you perform a head tilt-chin lift maneuver or jaw thrust on a patient to open their airway and are not able to ventilate the patient successfully, ...
How to determine OPA?
There are two common facial measurements recommended for determining the proper sized OPA: the distances between the maxillary incisors to the angle of the mandible, and the distance from the corner of the mouth to the angle of the mandible.
Which incisors are more acceptable for OPA?
These results indicate that to obtain adequate ventilation in conjunction with an acceptable endoscopic view, the maxillary incisors to the angle of the mandible measurement for an OPA is more acceptable.
What is a flexible LMA?
Flexible LMAs in sizes 2, 2.5, and 3 are also available for pediatric use. The cuff is similar to a standard LMA, but the airway tube is wire-reinforced, longer, and more flexible, allowing it to be positioned away from the surgical field. Although the flexibility of the tube is advantageous for positioning, it is more difficult to insert, it may dislodge more easily, and biting can occlude it. Moreover, the flexibility of this LMA does not allow the rotation technique for insertion. Adenoidectomy or even tonsillectomy can be performed with the flexible LMA, because the cuff prevents soiling of the glottis and the trachea by blood and secretions from the surgical site. If tracheal intubation is planned via LMA, a standard LMA is a more logical choice in children, because it is shorter and has a larger diameter; in adolescents or adults, the intubating LMA (Fastrach) can be used.
What is the LMA #1?
The #1 LMA, a miniature version of the adult LMA, was designed to fit infants who weigh less than 6.5 kg. It has worked satisfactorily even in premature infants as small as 1 kg, in newborn resuscitation, and in airway maintenance for infants with upper-airway congenital anomalies (e.g., Pierre-Robin, Goldenhar's, Treacher-Collins, and Schwartz-Jampel syndromes). In difficult intubating conditions, it has been used throughout the whole procedure or as a conduit for endotracheal intubation. The endotracheal tube can often be easily directed through an LMA without fiberoptic laryngoscopy.
How to determine oropharyngeal airway size?
The required airway size can be estimated by a careful external examination of the child and by measuring the distance from the teeth to the base of the tongue. An oropharyngeal airway device that is too small can displace the base of the patient's tongue inferiorly toward the pharynx, thereby increasing the degree of obstruction, which may worsen with the application of CPAP in an effort to improve the airway obstruction. An airway that is too large may reach the laryngeal inlet and result in trauma or laryngeal hyperactivity and laryngospasm. It is common practice by some clinicians to insert an oropharyngeal airway device upside down, or convex to the natural curvature of the tongue and then to rotate the airway 180 degrees. However, this maneuver may abrade the hard palate and it is therefore not recommended. A less traumatic technique for the insertion of an oropharyngeal airway device is to use a tongue depressor to displace the tongue to the floor of the mouth and to insert the device concave to the tongue's surface.
What is an airway adjunct?
Airway Adjuncts (Oral Airways, Nasopharyngeal Airways) Oropharyngeal (OP) and nasopharyngeal (NP) airways can be used to maintain airway patency, particularly during BVM ventilation, but provide no airway protection. In general, a patient who requires a device to maintain airway patency may also require intubation for airway protection.
What is the nasopharyngeal airway made of?
Nasopharyngeal airway devices are generally constructed from red rubber or polyvinyl chloride and are available in various sizes.
How to insert airway in oropharynx?
An alternative method of placement is to insert the airway backward (convex side toward the tongue) until the tip is close to the pharyngeal wall of the oropharynx. It is then rotated 180 degrees so that the tip rotates and sweeps under the tongue from the side (see Fig. 15-8D ). This method is not as reliable as the tongue blade–assisted technique described earlier, and it has the added risk of causing dental trauma in patients with poor dentition.
How to determine the proper length of nasopharyngeal airway?
The proper length for the nasopharyngeal airway may be estimated by measuring the distance between the patient's auditory meatus and the tip of the nose. The insertion of a nasopharyngeal airway device that is too long may cause laryngospasm.
What is an OP airway?
Oropharyngeal (OP) airways are curved plastic devices that assist in the maintenance of an adequate airway in the unresponsive casualty. The OP airway by itself does not replace correct airway management practices and should only be considered as a tool to assist in the management of a casualty’s airway.
How to insert an OP airway?
An OP airway can be inserted into an adult casualty’s mouth using the rotation method: Tilt the casualty’s head back; open the casualty’s mouth with one hand using jaw support (or jaw thrust, if necessary) Hold the OP airway by the flange with the tip pointing upwards towards the roof of the casualty’s mouth.
How long are OP airways?
OP airways come in a range of sizes allowing for insertion into different-sized casualties. The smallest OP airways are approximately 5 cm long and the larger OP airways are over 10 cm long. The bite block also assists with size recognition as there are different colours for different sizes.
Where should an OP airway be inserted?
The OP airway should be inserted into the unresponsive breathing casualty’s mouth either when they are on their back (pre ferred position) or on their side.
Can an OP airway be inserted into an adult's mouth?
An OP airway can be inserted into an adult casualty’s mouth using the rotation method:
Can you rotate an OP airway?
If inserting an OP airway into a child or infant, DO NOT rotate the device, but gently slide it straight in
Why do you need an 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.
How to sniff a patient?
To achieve the sniffing position, folded towels or other materials may need to be placed under the head, ne ck, or shoulders, so that the neck is flexed on the body and the head is extended on the neck. In obese patients, many folded towels or a commercial ramp device may be needed to sufficiently elevate the shoulders and neck. In children, padding is usually needed behind the shoulders to accommodate the enlarged occiput.
What is the goal of tongue relaxation?
The goal of all of these methods is to relieve upper airway obstruction caused by a relaxed tongue lying on the posterior pharyngeal wall.
Which airway is used concurrently with a nasopharyngeal airway?
An oropharyngeal airway used concurrently with a nasopharyngeal airway may improve oxygenation and ventilation.
What is the name of the apparatus used to remove easily accessible foreign bodies?
Various sizes of oropharyngeal airways. Suctioning apparatus and Yankauer catheter; Magill forceps (if needed to remove easily accessible foreign bodies), to clear the pharynx as needed. Nasogastric tube, to relieve gastric insufflation as needed.
Which notch is best for opening the upper airway?
Aligning the external auditory canal with the sternal notch may help open the upper airway and establishes the best position to view the airway if endotracheal intubation becomes necessary.
What is needed for placing neck and head into sniffing position?
Towels, sheets, or commercial devices as needed for placing neck and head into sniffing position
Why do you need an 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.
How to sniff a patient?
To achieve the sniffing position, folded towels or other materials may need to be placed under the head, ne ck, or shoulders, so that the neck is flexed on the body and the head is extended on the neck. In obese patients, many folded towels or a commercial ramp device may be needed to sufficiently elevate the shoulders and neck. In children, padding is usually needed behind the shoulders to accommodate the enlarged occiput.
What is the goal of tongue relaxation?
The goal of all of these methods is to relieve upper airway obstruction caused by a relaxed tongue lying on the posterior pharyngeal wall.
Which airway is used concurrently with a nasopharyngeal airway?
An oropharyngeal airway used concurrently with a nasopharyngeal airway may improve oxygenation and ventilation.
What is the name of the apparatus used to remove easily accessible foreign bodies?
Various sizes of oropharyngeal airways. Suctioning apparatus and Yankauer catheter; Magill forceps (if needed to remove easily accessible foreign bodies), to clear the pharynx as needed. Nasogastric tube, to relieve gastric insufflation as needed.
Which notch is best for opening the upper airway?
Aligning the external auditory canal with the sternal notch may help open the upper airway and establishes the best position to view the airway if endotracheal intubation becomes necessary.
What is needed for placing neck and head into sniffing position?
Towels, sheets, or commercial devices as needed for placing neck and head into sniffing position
Oropharyngeal vs Nasopharyngeal Airways
The decision to intubate is the first step in the placement of an advanced airway. It should be based on your primary survey, including the patient’s O2 saturation and vital signs as well. When a patient is in respiratory distress, he or she will present signs and symptoms such as the following.
What is an Oropharyngeal Airway Used for?
As the name implies, an oropharyngeal airway (OPA) is placed in the patient’s mouth and the distal end should stop at the level of the pharynx.
What is a Nasopharyngeal Airway Used for?
A nasopharyngeal airway (NPA) is inserted through the patient’s nose and the distal end stops at the level of the pharynx.
Contraindications
Using advanced airways has a lot of advantages, however, there are some contraindications you should be aware of. Using an OPA on a conscious patient with an intact gag reflex is contraindicated. A patient that can cough still has a gag reflex and using an OPA is not recommended.
Function and Indication
Insertion and Procedures
- Although airways are simple to use, it is important to select an appropriate size. If the airway is too small, its distal end will be obstructed by the tongue, resulting in inadequate ventilation.3 Radiographic assessment of the position of OPAs also demonstrated that the distal end of the airway may lodge in the vallecula or can be obstructed by the epiglottis. 5 If the OPA is too large…
Contraindications
- Using an oropharyngeal airway on a conscious patient with an intact gag reflex is contraindicated. Patients that can cough still have a gag reflex and an OPA should not be used. If the patient has a foreign body obstructing the airway, an OPA should also not be used. NPAs should not be used on patients who have nasal fractures or an actively bleedi...
Tips
- Be gentle when inserting either an oropharyngeal or nasopharyngeal airway.
- Avoid forcing an oropharyngeal airway, which can lead to trauma to the lips and tongue.
- Use caution when twisting the oropharyngeal 180 degrees to avoid trauma along the hard palate.
- Use a water-soluble lubricant when inserting a nasopharyngeal airway.