Oropharyngeal airway
An oropharyngeal airway (also known as an oral airway,OPA or Guedal 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 (either partially or completely) covering the epiglottis, which could prevent the patient from breathing. When a person becomes unconscious, the muscles in their jaw relax and may allow the tongue to obstruct the airway; in fact, the tongue is the most common cause of a blocked airway.[1] Oropharyngeal airways come in a variety of sizes, from infant to adult, and are used mostly in pre-hospital emergency care. This piece of equipment is utilized by certified first responders, emergency medical technicians, and paramedics when intubation is either not available or not advisable.
Oropharyngeal airways are usually indicated for unconscious patients, because there is a high probability that the device would stimulate a conscious patient's gag reflex. This could cause the patient to vomit and potentially lead to an obstructed airway. Nasopharyngeal airways are mostly used when the patient has a gag reflex, due to the fact that it can be used on a concious patient, whereas the oropharyngeal couldn't in the prehospital setting.
Insertion
The correct size OPA is chosen by measuring against the patient's head (from the earlobe to the corner of the oral opening). The airway is then inserted into the patient's 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. Measuring is very important, as the flared ends of the airway must rest securely against the oral opening in order to remain secure. 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.[2]
To remove the device, it is pulled out following the curvature of the tongue; no rotation is necessary.[2]
Usage
The airway does not remove the need for the recovery position: it does not prevent suffocation by liquids (blood, saliva, food, cerebrospinal fluid) or the closing of the glottis. But it facilitates the insufflations (cardiopulmonary resuscitation) for patients with a thick tongue.
Key risks of use
The mains risks of its use are:
- if the patient has a gag-reflex they may vomit
- when it is too large, it can close the glottis and thus close the airway
- inproper sizing can cause bleeding in the airway