A clear and open airway is fundamental for life, ensuring the body receives the oxygen it needs. When this pathway is compromised, the body’s ability to maintain adequate oxygen levels is severely hindered. Intervention is then necessary to restore and maintain airway patency, supporting respiration and preventing serious health complications.
Understanding the Oral Airway
An oral airway, also known as an oropharyngeal airway (OPA), is a medical device designed to help maintain an open upper airway. This J-shaped adjunct, typically made of rigid plastic, works by preventing the tongue from falling back and obstructing the throat, a common issue in unconscious individuals. The OPA features a flange that rests outside the mouth, a bite block to protect the patient’s teeth and prevent biting down, and a curved body that follows the natural curvature of the tongue and pharynx.
Its function is to displace the tongue forward, creating a clear channel for air. While the OPA does not secure the airway against aspiration of fluids or foreign bodies, it effectively addresses tongue-based obstruction. It also includes a central channel that allows for air passage and can facilitate suctioning of secretions.
Indications for Use
An oral airway is indicated for unconscious patients who cannot maintain their own airway and lack a protective gag reflex. When consciousness is lost, jaw and throat muscles relax, allowing the tongue to fall backward and block the airway. The OPA mechanically holds the tongue away from the posterior pharyngeal wall, ensuring an open passage.
This device is frequently used when a patient’s consciousness is impaired, such as during post-anesthesia recovery, after a drug overdose, or following a head injury. In cardiopulmonary resuscitation (CPR), an OPA can improve the effectiveness of rescue breaths by preventing airway obstruction. It can also be used during intubation procedures or to maintain airway patency when transferring sedated patients.
Correct Application and Sizing
Proper sizing is important for the effective and safe use of an oral airway. An incorrectly sized OPA can fail to clear the airway or cause harm. To determine the appropriate size, the OPA is measured from the corner of the patient’s mouth to the angle of their jaw, or from the central incisors to the angle of the mandible.
Once the correct size is selected, the OPA is inserted into the patient’s mouth using specific techniques. For adults, a common method involves inserting the airway upside down, with the tip pointing towards the roof of the mouth, until it reaches the soft palate. It is then rotated 180 degrees as it is advanced further, allowing the curve to guide the tongue forward and into proper position. For infants and children, direct insertion with the tip pointed downwards, often aided by a tongue depressor, is preferred to avoid potential trauma to their delicate oral structures.
Important Safety Guidelines
The use of an oral airway requires adherence to safety guidelines to prevent complications. It should never be used in conscious or semi-conscious patients, especially those with an intact gag reflex. Inserting an OPA in such individuals can trigger gagging, vomiting, and lead to aspiration, causing severe respiratory issues like laryngospasm.
Improper sizing or insertion can also result in complications, including trauma to the oral structures, such as damage to teeth or soft tissues of the mouth and throat. An OPA that is too small might push the tongue further back, worsening the obstruction, while one that is too large can extend too far down and stimulate the gag reflex or cause laryngospasm. Therefore, only trained medical professionals or first responders should insert an oral airway to ensure patient safety and proper airway management.