Chapter 2. Placement of Oropharyngeal Airway

• • Oropharyngeal airways provide a conduit for airflow through the mouth to the pharynx.

  • Oropharyngeal airways prevent mandibular tissue from obstructing the posterior pharynx.

  • Oropharyngeal airways may be used in the unconscious infant or child if procedures (ie, head tilt-chin lift or jaw thrust) to open the airway fail to provide and maintain a clear, unobstructed airway.

Absolute

• • Avoid inserting an oropharyngeal airway in conscious or semiconscious patients because it may stimulate gagging and vomiting.

• • Oropharyngeal airways come in various sizes ranging from 4 cm to 10 cm.

  • Oropharyngeal airways consist of a flange, a short bite-block segment, and a curved body usually made of plastic and shaped to provide an air channel and suction conduit through the mouth.

• • Oropharyngeal airways do not prevent aspiration.

• • Measure the distance from the central incisors to the angle of the mandible to approximate the correct size oral airway.

• • Head and airway must be positioned properly to maintain a patent airway even after insertion of an oropharyngeal airway.

• • The upper airway consists of the oropharynx, the nasopharynx, and supraglottic structures.

• • The airway can be placed with a tongue blade holding the tongue on the floor of the mouth.

  • Depress the tongue and gently glide the airway with the concave side downward, following the curvature of the tongue.

  • The airway can also be introduced upside down and gently rotated to the proper position, using rotation to pull the base of the tongue forward.

  • • Do not exert pressure on the palate if using this technique.

    • This technique is done without instrumentation.

  • Figure 2–1 shows an oral airway in place (sagittal view).

• • Monitor for airway obstruction; the following clinical signs may manifest:

  • • Agitation.

    • Desaturation.

    • Impaired air exchange when auscultated.

    • Diminished chest rise.

  • Use pulse oximetry to measure oxygen saturation levels.

  • Measure heart rate.

  • Check blood pressure using a noninvasive device.

• • If the oropharyngeal airway is too large, it may obstruct the larynx, make a tight mask fit difficult, and traumatize laryngeal structures.

  • If the oropharyngeal airway is too small or is inserted improperly, it pushes the tongue posteriorly, obstructing the airway.

  • If the oral airway is placed in the awake patient, it may induce vomiting, aspiration, and laryngospasm.

  • If the airway is too long, it may induce vomiting and aspiration.

• • The oropharyngeal airway may not be sufficient to relieve upper airway obstruction, and the patient may subsequently require intubation.