Maintaining an open airway is a fundamental part of providing basic life support to an unconscious person. When a patient becomes unresponsive, the muscles supporting the jaw and tongue relax, which can allow the tongue to fall backward and block the upper airway, a condition known as soft tissue obstruction. An Oropharyngeal Airway (OPA) is a simple, curved plastic device designed to prevent this specific type of blockage. This device is an adjunct used to maintain a clear passage for air until a person recovers or a more definitive airway management technique can be used.
Understanding the Oropharyngeal Airway and Its Purpose
The primary function of the OPA is to structurally lift the tongue away from the posterior pharynx, ensuring a patent airway for breathing or ventilation. In an unconscious patient, the base of the tongue is the most common anatomical cause of airway obstruction, collapsing against the back wall of the throat. The rigid, curved design of the OPA creates an open channel over the tongue, allowing air to flow freely from the mouth to the lungs.
The OPA is only indicated for patients who are completely unresponsive and lack a protective gag reflex. This device is frequently used during cardiopulmonary resuscitation (CPR) or in patients under deep sedation to facilitate manual ventilation with a bag-valve-mask (BVM) device. By preventing soft tissue collapse, the OPA reduces resistance, improving the effectiveness of assisted breathing and oxygen delivery. It is a temporary measure, providing support until the patient’s consciousness improves or advanced airway placement is achieved.
Selecting the Correct Size
Choosing the correct size OPA is important because an improperly sized device can worsen the airway obstruction or cause trauma. An airway that is too small may fail to hold the tongue forward and could push it further back into the throat. Conversely, one that is too large can press on the larynx, potentially causing injury or triggering a laryngospasm. The standard method for determining the appropriate length involves external facial measurement.
To size the OPA, hold the device alongside the patient’s face. Align the flat flange—the part that rests against the lips—with the corner of the patient’s mouth or central incisors. The curved tip of the OPA should then reach the angle of the mandible (the bony corner of the lower jaw). OPA devices are often color-coded, with a range of sizes from 40 mm to 110 mm, to aid in quick identification.
Step-by-Step Insertion Technique
Before insertion, the patient’s mouth should be opened using the cross-finger technique, and any visible debris, such as secretions or vomit, must be cleared by suctioning. The two primary insertion methods, the 180-degree rotation and the tongue depressor technique, are used depending on the patient’s age and clinical situation.
180-Degree Rotation Technique
This technique is generally preferred for adult patients. Insertion begins with the OPA upside down, with the curved tip pointing toward the roof of the mouth or the hard palate. As the tip reaches the junction of the hard and soft palate, the device is smoothly rotated 180 degrees. The rotation maneuver ensures the tip slides over the base of the tongue without pushing it backward, preventing obstruction. The device is advanced until the flange rests securely against the patient’s lips or teeth.
Tongue Depressor Technique
The tongue depressor technique is the safer method for children, infants, and patients with small oral openings. A tongue depressor is used to gently press the tongue down and forward, creating a clear path. The OPA is then inserted “right-side up,” with the curved tip pointing directly toward the pharynx, following the natural curve of the tongue. This approach minimizes the risk of soft tissue trauma to the delicate palate and pharynx that can occur with the rotation method in smaller patients.
Safety Considerations and Contraindications
The OPA must only be used in patients who are completely unconscious and have no intact gag reflex. The presence of a gag reflex is an absolute contraindication because insertion can stimulate vomiting, leading to the severe risk of pulmonary aspiration, where stomach contents enter the lungs. Patients who are conscious or semi-conscious should not receive an OPA, as they may not tolerate the device and could suffer oral trauma or laryngospasm.
Once the OPA is inserted, its proper placement must be immediately confirmed. The flange should rest flat against the lips, and the clinician should observe the patient’s chest for symmetrical rise and fall during breathing or assisted ventilation. Listening for clear breath sounds ensures the airway is open and functioning correctly. If the patient begins to cough, gag, or show signs of returning consciousness, the OPA must be removed instantly to prevent complications.