Oropharyngeal Airways (OPAs): Overview

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Questions and Answers

What is the primary function of the oropharyngeal airway (OPA) in an unconscious patient?

To prevent dental injuries during seizures

To restore patency in soft tissue airway obstruction (correct)

To perform advanced airway management

To facilitate the insertion of an intubation device

Which part of the OPA is in direct contact with the tongue and rests on top of it?

Tip

Lumen

Body (correct)

Flange

Which type of oropharyngeal airway has channels that allow a suction catheter or endotracheal tube to slide into the pharyngeal space?

Guedel

Williams

Jackson

Berman (correct)

What is a characteristic of the Guedel oropharyngeal airway?

Its central lumen can be used for suctioning Signup and view all the answers

Why is an oropharyngeal airway NOT indicated for conscious patients?

It may stimulate the pharyngeal reflex Signup and view all the answers

What is a potential use of an OPA for intubated patients?

Serving as a bite block Signup and view all the answers

In case of an unconscious patient, an OPA can help prevent injuries to:

The inside of the lips and cheeks Signup and view all the answers

Where does the tip of the OPA rest when properly inserted?

At the base of the tongue Signup and view all the answers

What should be considered when inserting an OPA in a seizing patient?

It should be avoided as it is NOT indicated Signup and view all the answers

What is the risk associated with inserting an oropharyngeal airway that is too long?

It could block airflow by forcing the tongue against the oropharynx. Signup and view all the answers

In the sizing of oropharyngeal airways, how is the correct length of the device verified?

The tip should reach the angle of the jaw when the flange is parallel to the front teeth. Signup and view all the answers

What patient positioning is recommended when preparing to insert an oropharyngeal airway, provided cervical injury is not a concern?

Supine or semi-Fowler's position with head tilted back Signup and view all the answers

Why should dentures be removed before inserting an oropharyngeal airway?

To avoid obstruction or displacement into the airway. Signup and view all the answers

What is the potential outcome of using an oropharyngeal airway that is too short?

The airway will not maintain patency effectively. Signup and view all the answers

Which classification of patient size correlates with an OPA size 4-5?

Medium adult Signup and view all the answers

Which method is recommended for opening the patient's mouth before inserting an OPA?

Cross-finger method Signup and view all the answers

What is the first step before inserting an oropharyngeal airway to ensure a clear path?

Suction the patient's mouth and pharynx. Signup and view all the answers

Which term describes the perpendicular flange's alignment during OPA measurement?

Front teeth Signup and view all the answers

What should be done first when inserting an oropharyngeal airway (OPA) into a patient?

Open the patient's mouth as wide as possible Signup and view all the answers

Why is the OPA initially inserted with its convex curvature toward the tongue?

To prevent pushing the tongue back into the pharynx Signup and view all the answers

What action should be taken if the patient begins to retch or gag during the OPA insertion?

Remove the airway immediately Signup and view all the answers

At what point during OPA insertion is the airway rotated 180 degrees?

When the airway reaches the base of the tongue Signup and view all the answers

Which method is preferred for inserting an OPA in infants and children?

Using a tongue blade to hold the tongue down Signup and view all the answers

What should the tip of the OPA point towards when it nears the posterior wall of the pharynx?

Downwards Signup and view all the answers

What is the purpose of the flange on an OPA?

To rest against the patient's lips Signup and view all the answers

How is the airway positioned when using a tongue blade to hold the tongue down?

Held in its normal upright position Signup and view all the answers

What should be avoided during the insertion of an OPA to prevent injury?

Putting excessive pressure on the tongue Signup and view all the answers

What should you do if a patient gags or is gasping for air after the insertion of an OPA?

Remove the OPA and recheck its size before reinsertion Signup and view all the answers

What can stridor, gasping, or snoring indicate after OPA insertion?

Airway displacement or increasing respiratory distress Signup and view all the answers

Why should OPAs not be taped in place?

Taping can lead to aspiration if the patient starts to gag or cough Signup and view all the answers

What should be frequently checked after the insertion of an OPA?

The position of the OPA Signup and view all the answers

What measures should be taken to clean an OPA for sub-acute or homecare use?

Rinse it with hydrogen peroxide and water, then use a pipe cleaner or cotton swab Signup and view all the answers

How should the lips and tongue of the patient be positioned in relation to the OPA?

Outside of the OPA Signup and view all the answers

What observation should be made to ensure equal lung function after OPA insertion?

Observe equal chest rise on both sides Signup and view all the answers

What is the proper method for removing an OPA?

Gently pull it outward and downward, following the mouth's natural curvature Signup and view all the answers

In which scenario is the use of a nasopharyngeal airway (NPA) most appropriate?

A recently extubated patient after facial surgery requiring frequent nasotracheal suctioning Signup and view all the answers

Which of the following is a contraindication for nasopharyngeal airway insertion?

Patients with basilar skull fractures Signup and view all the answers

What is the primary risk associated with NPA insertion in children?

Epistaxis Signup and view all the answers

What is the most important size consideration for an NPA?

Length of the airway Signup and view all the answers

Which of the following describes a potential issue with an NPA that is too long?

It may stimulate pharyngeal and laryngeal reflexes Signup and view all the answers

How is NPA length typically estimated?

Distance from the nares to the external auditory meatus Signup and view all the answers

What is a possible consequence of using an NPA that is too short?

Not establish patency Signup and view all the answers

Where should the tip of a properly inserted NPA be located?

Just above the epiglottis Signup and view all the answers

What direction should the bevel of an NPA face during insertion according to most instructions?

Towards the septum Signup and view all the answers

Why might clinicians not worry much about the bevel direction when inserting an NPA in the left nostril?

Standard instructions only apply to right nostril insertion Signup and view all the answers

When selecting a nostril for NPA insertion, which nostril is typically preferred?

The right nare Signup and view all the answers

What should be done if excessive resistance is felt during the insertion of an NPA?

Withdraw the NPA, re-lubricate, and try the other nare Signup and view all the answers

What potential risk is increased by rotating the NPA during insertion according to the provided guidelines?

Increased risk of trauma Signup and view all the answers

Why might the upside-down rotation procedure for NPA insertion be questioned in real-world applications?

It is primarily shown in manikins and drawings Signup and view all the answers

How should the NPA be directed during insertion to match the natural anatomy of the nasal passageways?

Straight back Signup and view all the answers

What alternative method can be used to facilitate the passage of the NPA into the oropharynx?

Passing a suction catheter through the NPA Signup and view all the answers

Which tissues are particularly susceptible to damage during NPA insertion?

Lymphoid tissue around sinuses Signup and view all the answers

What should the curvature of the NPA match during insertion?

The natural anatomic curve Signup and view all the answers

What is a sign that the NPA has reached the posterior nasopharyngeal wall?

Resistance will be felt Signup and view all the answers

Which lubricant should be applied to the NPA tip before insertion?

Water-soluble lubricant Signup and view all the answers

What is the purpose of the O2 reservoir in a BVM system?

To deliver additional oxygen to the patient Signup and view all the answers

What is the recommended ventilation rate when performing CPR with an endotracheal tube?

8-10 breaths per minute Signup and view all the answers

What is a potential complication of high ventilation rates (greater than 12/min) during CPR?

Gastric inflation Signup and view all the answers

Why might COPD patients require a slower ventilation rate with a BVM?

To prevent air trapping and auto PEEP Signup and view all the answers

What is barotrauma and why is it not usually a concern with adult BVMs?

Trauma due to high pressure; not a concern due to normal mask leakage Signup and view all the answers

Study Notes

Oropharyngeal Airways (OPAs): Overview

OPAs are simple devices used to restore patency in soft tissue airway obstruction in unconscious patients.

OPA Structure and Design

OPAs are made of hard plastic, with a semicircular shape that conforms to the curvature of the palate.
Each OPA has three parts: the flange, the body, and the tip.
The body follows the contour of the roof of the mouth and rests on top of the tongue.
The tip, the distal end, sits at the base of the tongue.

Types of OPAs

There are two common types of OPAs: Berman and Guedel.
The Berman OPA has channels along each side that allow a suction catheter or endotracheal tube to slide into the pharyngeal space.
The Guedel OPA is a tubular device, its central lumen can be used for suctioning, but it cannot accommodate an ET tube.

Placement and Function

When properly inserted, an OPA holds the tongue away from the posterior pharynx, allowing air to pass through and around the device.
OPAs can be easily inserted at the bedside without instruments.
OPAs facilitate suctioning in unconscious patients.

Indications and Contraindications

OPAs are used to prevent patients from biting their tongue and the inside of their lips and cheeks.
OPAs can be used as a bite block with intubated patients.
OPAs are NOT indicated for conscious patients, as they could stimulate the pharyngeal reflex.
OPAs are NOT indicated for patients who are actively seizing.

Oropharyngeal Airway Sizing

Oropharyngeal Airway (OPA) size is based on patient's body size: • Large adult size: 5-6 • Medium adult size: 4-5 • Small adult size: 3-4

Measuring Technique

Use the device itself as a measuring gauge: • Place the device on the patient's cheek, flange parallel to front teeth • Tip of the oropharyngeal airway should reach the angle of the jaw

Importance of Proper Sizing

If the airway is too long, it could obstruct breathing by displacing the tongue against the oropharynx
If the OPA is too short, it won't be able to hold the tongue away from the pharynx, and airway patency won't be restored

Insertion Technique

Before insertion: • Suction the patient's mouth and pharynx to remove secretions • Place the patient in a supine or semi-Fowler's position and tilt the head back (unless contraindicated by cervical injury)
With gloved hands: • Remove dentures • Prepare to insert the device
Open the patient's mouth using the cross-finger method: • Place thumb on the bottom teeth and index finger on the upper teeth • Gently push the upper jaw (maxilla) and the lower jaw (mandible) apart

Oropharyngeal Airway Insertion

Insert the airway upside down with the convex curvature toward the tongue to prevent pushing the tongue back into the pharynx.
Gently slide the airway over the tongue with the tip toward the back of the mouth to avoid dislodging teeth or damaging mouth tissue.
If the patient begins to retch or gag, remove the airway.
When the airway reaches the base of the tongue, rotate the device 180 degrees so the tip points down as it approaches the posterior wall of the pharynx.
The convex curvature should follow the contour of the roof of the mouth.

Alternative Method for Infants and Children

Hold the airway in its normal upright position and use a tongue blade to hold the tongue down.
Slide the airway carefully over the tongue and into position.

Description of the Oropharyngeal Airway

The airway is a curved plastic tube with a flange at the proximal end.
The airway is inserted upside down and then rotated into position to ensure the flange protrudes from the mouth and rests against the patient's lips.
The convex curvature of the airway is aligned along the back of the tongue to prevent the patient's tongue from blocking the entrance to the trachea.

Oropharyngeal Airways (OPAs) Insertion and Care

If a patient gags or gasps for air after OPA insertion, remove the airway and recheck the size before reinsertion
Stridor, gasping, or snoring may indicate airway displacement or increasing respiratory distress

Key Considerations for OPA Use

Ensure the patient's lips and tongue are not between their teeth and the OPA
Auscultate the lungs and observe equal chest rise on both sides to confirm proper placement
OPAs should not be taped in place, as this can lead to aspiration if the patient gags or coughs

Post-Insertion Care

Frequently check the OPA's position to ensure proper placement
Suction excess secretions as necessary and monitor the patient's respiratory status
Remove the OPA periodically to prevent tissue irritation and ulceration of the mucous membranes of the mouth

OPA Removal and Cleaning

Remove the OPA by gently pulling it outward and downward, following the mouth's natural curvature
Clean the airway by rinsing it with hydrogen peroxide and water, and use a pipe cleaner or cotton swab to remove secretions from the side channels or central lumen

Nasopharyngeal Airway (NPA) Introduction and Sizing

Indications for NPA include when oral airway is not possible, frequent nasotracheal suctioning is required, and to prevent Superior Turbinate Airway Obstruction (STAO) in patients recently extubated after facial surgery.
Contraindications for NPA include patients on anticoagulants, basilar skull fractures, and nasal deformities.
Children are at high risk for epistaxis (nosebleed) when an NPA is inserted.

NPA Characteristics and Insertion

NPA is shaped to follow the natural curvature of the nasopharynx.
When fully inserted, the tip is just above the epiglottis, separating the soft palate and tongue from the posterior wall of the oropharynx.
Flexible nature of the airway and use of adequate water-soluble lubricant allows the airway to naturally find the proper position when inserted.

NPA Sizing

NPA length is estimated as the distance from the nares to the external auditory meatus of the ears.
NPA length is the most important size consideration.
An NPA that is too short will not establish patency.
An NPA that is too long may pass into the larynx, stimulating pharyngeal and laryngeal reflexes, or end up in the vallecular.
Bevel of the NPA is on the right side of the airway.
Bevel should face the septum during insertion (but not necessary for left nostril insertion).

Nasopharyngeal Airway (NPA) Insertion

Identify the largest, most patent nostril (usually the right nostril) for NPA insertion.
Apply a water-soluble lubricant to the NPA tip and insert it gently below the inferior turbinate and close to the septum, matching the curvature of the NPA to the natural anatomic curve.
Direct the NPA straight back, as the nasal passageways go straight back.
Avoid damaging lymphoid tissue around the sinuses and abrading the delicate nasal mucosa, which can cause bleeding.
Resistance will be felt when the NPA meets the posterior nasopharyngeal wall.
If necessary, slightly rotate the airway or pass a suction catheter through the NPA to guide it past the angle into the oropharynx.
If excessive resistance is felt, withdraw the NPA, re-lubricate, and try the other nostril.
Some procedures recommend inserting the NPA upside down (like an OPA) and then rotating it, especially for left nostril insertion.
However, this method is often shown in drawings and with manikins, and may not be suitable for real-world use, as it can make insertion more difficult and increase the risk of trauma.

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Description

Learn about Oropharyngeal Airways, devices used to restore patency in soft tissue airway obstruction in unconscious patients, including their structure and design.