The oropharyngeal airway (OPA) is a specialized plastic device designed to maintain an open air passage in unconscious or unresponsive individuals. This curved adjunct prevents the patient’s tongue from falling back and obstructing the pharynx, a common cause of breathing difficulty when muscle tone is lost. The OPA is intended for temporary use to ensure continuous airflow and facilitate ventilation during resuscitation or recovery. Placement of this device is a medical procedure requiring certified training and should only be attempted by qualified healthcare providers.
Selecting the Right Airway and Patient Assessment
The decision to use an OPA begins with assessing the patient’s neurological status and protective reflexes. The OPA is used only in unresponsive patients who cannot maintain an open airway and lack an intact gag reflex. If a semi-conscious patient has a gag reflex, insertion can stimulate vomiting and subsequent aspiration. For this reason, the OPA must be immediately removed if the patient begins to gag or cough during the procedure.
Correct sizing of the OPA is paramount, as an improperly sized device can worsen airway obstruction. The standard method involves placing the flange at the corner of the patient’s mouth and aligning the tip with the angle of the jaw or the earlobe. This measurement ensures the curved tip sits correctly behind the tongue, holding it forward without pressing against the epiglottis. An OPA that is too small may push the tongue further back, while one that is too large risks trauma or airway spasm.
Step-by-Step Insertion Techniques
Before attempting insertion, the patient’s head must be properly positioned to align the airway axes. If neck trauma is not suspected, the head-tilt/chin-lift maneuver is used to open the airway. If a head or neck injury is possible, the jaw-thrust maneuver minimizes cervical spine movement while still lifting the tongue. Any visible foreign material or secretions must be cleared from the mouth using suction before the OPA is introduced.
The most common technique for adult OPA placement is the 180-degree rotation method. The device is first inserted into the mouth with the tip pointing toward the roof of the mouth. It is advanced until the tip reaches the back of the throat. The OPA is then rotated 180 degrees so the tip points toward the pharynx, following the natural curve of the tongue.
An alternative approach, often preferred in pediatric patients, is the tongue blade method, which avoids the rotation step. A tongue depressor holds the tongue down and forward while the OPA is inserted right-side up, with the curve already facing the tongue. Insertion is complete when the outer flange rests flush against the patient’s lips or teeth. Lubrication with a water-soluble gel may be used to assist with smooth insertion.
Confirming Placement and Monitoring
Immediate confirmation of proper OPA placement is necessary to ensure the device is functioning. The visual check confirms that the flange rests against the lips and the tip is not visible in the back of the throat, which would indicate over-insertion. The primary sign of success is the immediate improvement in the patient’s breathing, evidenced by a reduction in noisy or obstructed airflow.
Once the airway is placed, the provider should look for symmetrical chest rise and fall during ventilation. Auscultation over the lungs should reveal clear, bilateral breath sounds, confirming that air moves freely through the trachea. If the patient’s breathing worsens or a snoring sound persists, the OPA may be incorrectly positioned, and the head or device should be gently repositioned.
Continuous assessment of the patient’s level of consciousness is necessary. Since the OPA is a temporary device, its continued presence is only safe while the patient remains deeply unconscious. If the patient shows signs of regaining consciousness, such as purposeful movement or a return of the gag reflex, the OPA must be removed immediately to prevent vomiting and aspiration. Suction should be readily available as a safety precaution against regurgitation or excessive secretions.