Oropharyngeal airway
Encyclopedia
An oropharyngeal airway (also known as an oral airway, OPA or Guedel pattern airway) is a medical device called an airway adjunct used to maintain a patent (open) airway
. It does this by preventing the tongue
from covering the epiglottis
, which could prevent the person from breathing. When a person becomes unconscious, the muscles in their jaw relax and allow the tongue to obstruct the airway.
.
Oropharyngeal airways come in a variety of sizes, from infant to adult, and are used commonly in pre-hospital emergency care and for short term airway management post anaesthetic or when manual methods are inadequate to maintain an open airway. This piece of equipment is utilized by certified first responder
s, emergency medical technician
s, and paramedics - plus other health professionals when tracheal intubation
is either not available, not advisable or the problem is of short term duration.
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. Nasopharyngeal airway
s are mostly used instead as they do not stimulate a gag reflex.
In general oropharyngeal airways need to be sized and inserted correctly to maximise effectiveness and minimise possible complications - such as oral trauma.
The correct size OPA is chosen by measuring from the middle of the persons mouth to the angle of the jaw. The airway is then inserted into the persons mouth upside down. Once contact is made with the back of the throat, the airway is rotated 180 degrees, allowing for easy insertion, and assuring that the tongue is secured. An alternative method for insertion, the method that is recommended for OPA use in children and infants, involves holding the tongue forward with a tongue depressor
and inserting the airway right side up.
The device is removed when the person regains swallow reflex and can protect their own airway. Simply remove by pulling on it without rotation.
and ongoing assessment of the airway and it does not prevent obstruction by liquids (blood, saliva, food, cerebrospinal fluid) or the closing of the glottis
. But can facilitate ventilation during CPR (cardiopulmonary resuscitation
) and for persons with a large tongue.
Airway
The pulmonary airway comprises those parts of the respiratory system through which air flows, conceptually beginning at the nose and mouth, and terminating in the alveoli...
. It does this by preventing the tongue
Tongue
The tongue is a muscular hydrostat on the floors of the mouths of most vertebrates which manipulates food for mastication. It is the primary organ of taste , as much of the upper surface of the tongue is covered in papillae and taste buds. It is sensitive and kept moist by saliva, and is richly...
from covering the epiglottis
Epiglottis
The epiglottis is a flap that is made of elastic cartilage tissue covered with a mucous membrane, attached to the entrance of the larynx. It projects obliquely upwards behind the tongue and the hyoid bone, pointing dorsally. The term, like tonsils, is often incorrectly used to refer to the uvula...
, which could prevent the person from breathing. When a person becomes unconscious, the muscles in their jaw relax and allow the tongue to obstruct the airway.
History and usage
The oropharyngeal airway was designed by Arthur GuedelArthur Ernest Guedel
Arthur Ernest Guedel was an American anesthesiologist. He was known for his studies on the uptake and distribution of inhalational anesthetics, as well for defining the various stages of general anesthesia.-References:...
.
Oropharyngeal airways come in a variety of sizes, from infant to adult, and are used commonly in pre-hospital emergency care and for short term airway management post anaesthetic or when manual methods are inadequate to maintain an open airway. This piece of equipment is utilized by certified first responder
Certified first responder
A certified first responder is a person who has completed a course and received certification in providing pre-hospital care for medical emergencies. They have more skill than someone who is trained in basic first aid but they are not a substitute for advanced medical care rendered by emergency...
s, emergency medical technician
Emergency medical technician
Emergency Medical Technician or Ambulance Technician are terms used in some countries to denote a healthcare provider of emergency medical services...
s, and paramedics - plus other health professionals when tracheal intubation
Tracheal intubation
Tracheal intubation, usually simply referred to as intubation, is the placement of a flexible plastic or rubber tube into the trachea to maintain an open airway or to serve as a conduit through which to administer certain drugs...
is either not available, not advisable or the problem is of short term duration.
Oropharyngeal airways are indicated only in unconscious
Coma
In medicine, a coma is a state of unconsciousness, lasting more than 6 hours in which a person cannot be awakened, fails to respond normally to painful stimuli, light or sound, lacks a normal sleep-wake cycle and does not initiate voluntary actions. A person in a state of coma is described as...
people, because of the likelihood that the device would stimulate a gag reflex in conscious or semi-conscious persons. This could result in vomit
Vomiting
Vomiting is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose...
and potentially lead to an obstructed airway. Nasopharyngeal airway
Nasopharyngeal airway
In medicine, a nasopharyngeal airway, also known as an NPA or a nasal trumpet because of its flared end, a type of airway adjunct, is a tube that is designed to be inserted into the nasal passageway to secure an open airway. When a patient becomes unconscious, the muscles in the jaw commonly relax...
s are mostly used instead as they do not stimulate a gag reflex.
In general oropharyngeal airways need to be sized and inserted correctly to maximise effectiveness and minimise possible complications - such as oral trauma.
Insertion
The correct size OPA is chosen by measuring from the middle of the persons mouth to the angle of the jaw. The airway is then inserted into the persons mouth upside down. Once contact is made with the back of the throat, the airway is rotated 180 degrees, allowing for easy insertion, and assuring that the tongue is secured. An alternative method for insertion, the method that is recommended for OPA use in children and infants, involves holding the tongue forward with a tongue depressor
Medical device
A medical device is a product which is used for medical purposes in patients, in diagnosis, therapy or surgery . Whereas medicinal products achieve their principal action by pharmacological, metabolic or immunological means. Medical devices act by other means like physical, mechanical, thermal,...
and inserting the airway right side up.
The device is removed when the person regains swallow reflex and can protect their own airway. Simply remove by pulling on it without rotation.
Usage
Use of an OPA does not remove the need for the recovery positionRecovery position
The recovery position refers to one of a series of variations on a lateral recumbent or three-quarters prone position of the body, in to which an unconscious but breathing casualty can be placed as part of first aid treatment.An unconscious person The recovery position refers to one of a series of...
and ongoing assessment of the airway and it does not prevent obstruction by liquids (blood, saliva, food, cerebrospinal fluid) or the closing of the glottis
Glottis
The glottis is defined as the combination of the vocal folds and the space in between the folds .-Function:...
. But can facilitate ventilation during CPR (cardiopulmonary resuscitation
Cardiopulmonary resuscitation
Cardiopulmonary resuscitation is an emergency procedure which is performed in an effort to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person in cardiac arrest. It is indicated in those who are unresponsive...
) and for persons with a large tongue.
Key risks of use
The mains risks of its use are:- if the person has a gag-reflex they may vomit
- when it is too large, it can close the glottis and thus close the airway
- improper sizing can cause bleeding in the airway
See also
- Airway managementAirway managementIn cardiopulmonary resuscitation, anaesthesia, emergency medicine, intensive care medicine and first aid, airway management is the process of ensuring that:# there is an open pathway between a patient’s lungs and the outside world, and...
- Bag valve maskBag valve maskA bag valve mask is a hand-held device used to provide positive pressure ventilation to a patient who is not breathing or who is breathing inadequately. The device is a normal part of a resuscitation kit for trained professionals, such as ambulance crew...
- Guedel's classificationGuedel's classificationGuedel's classification is a means of assessing of depth of general anesthesia introduced by Arthur Ernest Guedel in 1937.-History:...
of stages of anesthesiaAnesthesiaAnesthesia, or anaesthesia , traditionally meant the condition of having sensation blocked or temporarily taken away... - Endotracheal tube
- Laryngeal mask airwayLaryngeal mask airwayThe laryngeal mask airway is a supraglottic airway device invented by Archie Brain, a British anaesthetist.-Description:Laryngeal masks consist of a tube with an inflatable cuff that is inserted into the pharynx. Laryngeal mask airways come in a variety of sizes ranging from large adult to infant...
- Nasopharyngeal airwayNasopharyngeal airwayIn medicine, a nasopharyngeal airway, also known as an NPA or a nasal trumpet because of its flared end, a type of airway adjunct, is a tube that is designed to be inserted into the nasal passageway to secure an open airway. When a patient becomes unconscious, the muscles in the jaw commonly relax...