How To Insert an Oropharyngeal Airway? (2)

Oropharyngeal Airway Positioning

Sniffing Position—Only if there is no cervical spine injury:

• Place the patient supine on a stretcher.
• Align the upper airway for optimal airway by placing the patient in the proper sniffing position. The proper sniffing position aligns the external auditory meatus with the sternal notch. To achieve the sniffing position, it may be necessary to place folded towels or other material under the head, neck, or shoulders so that the neck is flexed over the body and the head is extended over the neck. For obese patients, many folded towels or a commercial ramp device may be needed to adequately elevate the shoulders and neck. For children, padding is often required behind the shoulders to accommodate the enlarged occipital bone.

If there is a possibility of cervical spine injury:

• Place the patient supine or at a slight inclination on a stretcher.
• Avoid moving the neck and manually open the upper airway using only jaw thrusts or chin lifts without tilting the head.

Step-by-step instructions for oropharyngeal airway surgery

• Clear obstructing secretions, vomitus, or foreign bodies from the oropharynx as needed.
• Determine the appropriate size of oropharyngeal airway. Place the airway next to the patient's cheek with the flange at the corner of the mouth. The tip of an appropriately sized airway should just reach the angle of the mandibular ramus.
• Next, begin inserting the airway into the mouth with the tip pointing toward the roof of the mouth (i.e., concave upward).
• To avoid cutting the lips, be careful not to pinch the lips between the teeth and the airway as you insert the airway.
• As you advance the airway into the posterior oropharynx, rotate it 180 degrees. This technique prevents the airway from pushing the tongue back during insertion and further obstructing the airway.
• When fully inserted, the flange of the device should rest on the patient's lips.
• Alternatively, use a tongue depressor to hold the tongue down and insert the airway with the tip pointing toward the floor of the mouth (i.e., concave downward). Using a tongue depressor prevents the airway from pushing the tongue back during insertion.

Follow-up Care of the Oropharyngeal Airway

• Ventilate the patient as needed.
• Monitor the patient and identify and correct any factors that impede normal ventilation and oxygenation.
• If the oropharyngeal airway should remain in place (e.g., during mechanical ventilation after orotracheal intubation), the oropharyngeal airway should be secured.

Oropharyngeal Airway Warnings and Common Mistakes

• An oropharyngeal airway should only be used if the patient is unconscious or unresponsive, as this may stimulate vomiting, creating an aspiration risk. For unresponsive patients with an intact gag reflex, a nasopharyngeal airway is the preferred choice.