The Oropharyngeal Airway (OPA) is a curved, rigid plastic device used to maintain an open airway. It sits in the oropharynx, preventing the tongue from collapsing against the back of the throat, the most common cause of obstruction in unresponsive patients. OPA insertion is a high-risk, technical skill reserved only for trained medical professionals (e.g., paramedics, nurses, and doctors). Understanding the procedure illuminates the precise and delicate nature of infant airway management.
When Airway Insertion is Necessary
The decision to insert an OPA relies on the patient’s level of consciousness and protective reflexes. It is indicated only when the infant is completely unconscious and unable to maintain their own airway. Unconsciousness causes loss of muscle tone, allowing the tongue to fall backward and block the airway, preventing effective breathing.
A primary requirement is the absence of a gag reflex, which is a key protective mechanism against aspiration. If simple maneuvers (e.g., head tilt-chin lift or jaw thrust) fail to correct the obstruction, the OPA holds the tongue forward. It provides a clear conduit for airflow, often necessary when assisted ventilation with a bag-valve-mask is required. Insertion when the gag reflex is present risks triggering vomiting and subsequent aspiration into the lungs.
Selecting the Correct Size for an Infant
Selecting the correct OPA size is paramount in infants, as their delicate anatomy is highly susceptible to injury or worsened obstruction from an ill-fitting device. Sizing involves measuring the device against the infant’s external facial anatomy. The OPA should extend from the center of the mouth (typically the central incisors) to the angle of the jaw (mandible).
A device that is too small is ineffective and may push the tongue further back, worsening the obstruction. Conversely, a device that is too long is dangerous, as the tip can extend past the pharynx and press down on the epiglottis. This pressure risks stimulating the vagus nerve, inducing laryngospasm, or causing direct tracheal injury. Precise measurement ensures the tip rests appropriately at the entrance of the oropharynx without reaching the sensitive laryngeal structures.
Safe Insertion Technique
The insertion technique for infants differs significantly from the method used in older children and adults to protect vulnerable oral and pharyngeal tissues. Unlike the adult technique (inserting upside down and rotating 180 degrees), the infant OPA is inserted directly into the mouth in its final orientation. This modification avoids trauma to the infant’s delicate soft palate, which is easily damaged during rotation.
The accepted method uses a tongue depressor to gently push the tongue down and forward, clearing the pathway. The OPA is then gently slid over the tongue, curved side facing the floor of the mouth, until the flange rests against the lips. Direct insertion allows for continuous visual confirmation, ensuring the tongue is not inadvertently pushed backward. Gentle handling and minimal force are required to prevent soft tissue damage and reduce the risk of stimulating a gag reflex.
Risks and Situations Where Use is Prohibited
The primary contraindication for OPA insertion is any sign of an intact protective reflex, most notably the gag reflex. A semi-conscious patient may not tolerate the device, and its use can trigger immediate vomiting and subsequent aspiration. Other contraindications include known or suspected foreign body obstruction or severe trauma to the mouth or jaw that prevents proper seating.
Common complications include localized soft tissue injury, such as minor bleeding or abrasions to the palate or tongue, especially if excessive force is used. Due to the risk of inducing vomiting, suction equipment must be immediately available to clear the airway if the infant reacts. The OPA requires continuous monitoring; any sign of the infant regaining consciousness or coughing is an immediate indication for removal.