An oropharyngeal airway (also known as an oral airway, OPA or Guedel pattern airway) is a medical device called an ''airway adjunct'' used in

airway management Airway management includes a set of maneuvers and medical procedures performed to prevent and relieve an airway obstruction. This ensures an open pathway for gas exchange between a patient's lungs and the atmosphere. This is accomplished by either ...

to maintain or open a patient's airway. It does this by preventing the

tongue The tongue is a Muscle, muscular organ (anatomy), organ in the mouth of a typical tetrapod. It manipulates food for chewing and swallowing as part of the digestive system, digestive process, and is the primary organ of taste. The tongue's upper s ...

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.

History and usage

The oropharyngeal airway was designed by Arthur Guedel. 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 responders, emergency medical technicians, paramedics, anesthesia providers, and other health professionals when

tracheal intubation Tracheal intubation, usually simply referred to as intubation, is the placement of a flexible plastic catheter, tube into the vertebrate trachea, trachea (windpipe) to maintain an open airway or to serve as a conduit through which to administer c ...

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

vomiting Vomiting (also known as emesis, puking and throwing up) is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose. Vomiting can be the result of ailments like food poisoning, gastroenteritis, pre ...

and potentially lead to an obstructed airway. Nasopharyngeal airways are mostly used instead as they do not stimulate a gag reflex. In general, oropharyngeal airways need to be sized and inserted correctly to maximize effectiveness and minimize possible complications, such as oral trauma.

Insertion

The correct size OPA is chosen by measuring from the first incisors to the angle of the jaw. The airway is then inserted into the person'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. 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, or it is substituted for an advanced airway. It is removed simply by pulling on it without rotation.

Usage

Use of an OPA does not remove the need for the recovery position 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 The glottis (: glottises or glottides) is the opening between the vocal folds (the rima glottidis). The glottis is crucial in producing sound from the vocal folds. Etymology From Ancient Greek ''γλωττίς'' (glōttís), derived from ''γ ...

. It can, however, facilitate ventilation during CPR (

cardiopulmonary resuscitation Cardiopulmonary resuscitation (CPR) is an emergency procedure used during Cardiac arrest, cardiac or Respiratory arrest, respiratory arrest that involves chest compressions, often combined with artificial ventilation, to preserve brain function ...

) and for persons with a large tongue.

Types of oropharyngeal airways

Some of the types of oropharyngeal airways include: * Guedel * COPA * Ovassapian * Williams * Berman * Optosafe * Berman-Split The most commonly used oropharyngeal airway is the Guedel style. However, the landscape of oropharyngeal airways has expanded to include various designs tailored for specific medical procedures. Among these designs, those developed to facilitate flexible bronchoscopy are notable. Those include the Berman, the Berman-Split, Optosafe, the Ovassapian and Williams airways. The Ovassapian Intubating Airway has two sections of curved walls between its side walls to guide the passage of the fiberoptic endoscope, while its distal lingual half has no posterior wall. The Williams Airway Intubator has a distal half that is open on its lingual surface, in contrast its proximal half consists of a cylindrical tunnel. Another notable alternative oropharyngeal airawy design is the Cuffed oropharyngeal airways (COPA). It intends to provide a better fit in the oropharynx by adding an inflatable cuff to a Guedel style airway.

Risks of use

The main risks of its use are: * Airway hyperreactivity including retching, emesis, coughing, laryngospasm, and bronchospasm * Iatrogenic trauma such as pinching of the lips and tongue, dental trauma. Prolonged insertion can cause tongue necrosis or edema, uvular edema, or lip damage

References

External links

ISO 5364:2016 Anaesthetic and respiratory equipment — Oropharyngeal airways
{{DEFAULTSORT:Oropharyngeal Airway Airway management First aid Emergency medicine