Overview of Oropharyngeal Airway
Acute respiratory failure, which can lead to serious heart problems and death, can be caused by a variety of factors. Quick and effective airway management is essential to ensure proper breathing and oxygen levels, preventing the situation from worsening. If someone is having breathing difficulties, managing their airways is also crucial during cardiopulmonary resuscitation (CPR). This is particularly true for children, as they often visit emergency departments because of respiratory distress.
A series of initial steps can simplify airway management. These steps include positioning the airway (using techniques like the head-tilt-chin lift or jaw-thrust), suctioning (removing mucus or other blockages from the airway), providing extra oxygen, and readjusting the airway position if needed. These techniques aim to clear the airway and allow for better breathing. However, if someone has a neck injury, certain positioning techniques may need to be avoided to prevent further harm.
Sometimes these initial steps aren’t enough to maintain a clear airway or provide sufficient oxygen. In these cases, an ‘airway adjunct’, an additional tool or technique, may need to be used to relieve the blockage.
However, certain people are more susceptible to having an airway blockage. People who are overweight may face increased risk because excess fat can affect the structure of the airway, potentially causing it to collapse. This can be made worse if they take certain medications that affect the central nervous system, or if they have conditions like obstructive sleep apnea (OSA) or obstructive hypoventilation syndrome (OHS) that can cause breathing issues during sleep.
Children, especially babies and toddlers, are also prone to airway obstruction. This is because their airway structure is different than adults. For instance, their relatively large back of the head can cause their neck to bend when they lie on their back, obstructing the airway. Also, children have a larger tongue compared to their oral cavity, which can contribute to airway blockage. They also have more pliable airways compared to adults, making them more susceptible to blockages. Around the age of eight, a child’s airway becomes more similar to that of an adult.
To manage airway obstruction, health professionals often use two main types of airway adjuncts: oral airway and nasal airway adjuncts. This article mainly focuses on the oral airway adjunct.
Why do People Need Oropharyngeal Airway
An oropharyngeal airway, also known as an oral airway or OPA, is a device used to keep the airway open. It works by stopping the tongue from blocking a part of the throat called the epiglottis. The epiglottis acts like a flap and, when covered, can stop a person from breathing properly. This can occur when someone is unconscious, as the jaw muscles relax and the tongue can obstruct the breathing passage. So, the OPA helps keep the airway clear, ensuring the person can breathe unhindered.
When a Person Should Avoid Oropharyngeal Airway
If a patient is awake and still able to gag (a reflex that aids in keeping foreign objects out of the throat), an oropharyngeal airway should not be used. An easy way to check for this reflex is to see if the patient can cough; if they can, then they still have this reflex. So, in this case, an oral device designed to keep the airway open, also known as an oropharyngeal airway, should not be used. Furthermore, an oropharyngeal airway is also a bad option when there’s something stuck in the patient’s airway.
This device also should not be used in instances where the patient has a broken nose or is suffering from an active nosebleed.
Preparing for Oropharyngeal Airway
An oropharyngeal airway is a device that helps a patient breathe usually during medical procedures. It consists of four parts: the flange, the body, the tip, and a channel. These parts help the passage of air and release of suction from the mouth. These airways come in many sizes based on the patient’s build (e.g., from 40 mm to 110 mm).
The correct size for a patient is decided by comparing it with known body features. For example, the flange, which is the wide part at one end, should fit snugly against the patient’s lips, while the tip should comfortably reach the corner of the lower jaw.
Inserting this device should be done carefully to prevent making any breathing problems worse or harming the patient’s airway. That’s why it’s crucial to choose the correct size and insert it properly.
How is Oropharyngeal Airway performed
There are different methods to insert an oropharyngeal airway, which is a device that helps to keep your airway open, especially in emergency situations. Here are three examples that doctors use:
Method 1: The doctor would first gently open up your mouth. They will then use a flat and thin instrument, typically called a tongue depressor, to push your tongue down. While doing this, they would carefully insert the oropharyngeal airway into your mouth. The tip of this device would be facing towards the back of your throat, and it goes over your tongue.
Method 2: Like in the first method, the doctor would open up your mouth. But this time, they would insert the oropharyngeal airway with its tip facing towards the front of your throat. As the doctors slip this device into the mouth, they would rotate it 180 degrees until it reaches the back of your throat. However, using this method might present some risk of hurting the upper part of your mouth, both the hard and soft parts.
Method 3: In this technique, after opening the mouth, the doctor would place the oropharyngeal airway in your mouth with its tip pointing towards one corner. As this device is moved to the back of your throat, it is rotated 90 degrees.
Remember, the aim of these methods is to make sure your airway stays open so you can breathe properly. The method a doctor will use depends on your specific condition and their professional judgement.
Possible Complications of Oropharyngeal Airway
If you’re getting an oropharyngeal airway (a tool used to keep your airway open), there can be a few complications. It might make you throw up, which could potentially cause you to choke or breathe in food or other foreign material. This is known as aspiration.
Also, if the tool used to keep the airway open doesn’t fit properly, it can either lead to or worsen any blockage in your airway. If it’s too small, you might have difficulty breathing. On the other hand, if it’s too large, it could potentially trigger a laryngospasm, which is an involuntary muscle spasm that closes up the voice box.
Finally, the oropharyngeal airway might accidentally harm your mouth or teeth when it’s being put in.
What Else Should I Know About Oropharyngeal Airway?
Having a clear, open airway is crucial for successful resuscitation, which is the process of reviving someone who has stopped breathing or whose heart has stopped. However, a blockage in the upper airway can make resuscitation difficult because it prevents enough oxygen from getting into the lungs.
An oropharyngeal airway is a medical device that is used to overcome this obstacle. It can help bypass an obstruction in the mouth, like enlarged tonsils, to make oxygen flow easier. For patients lying on their backs, it also prevents the tongue from falling back and blocking the throat, a common issue in such cases.
This device is particularly useful in making ‘bag-mask ventilation’ more effective. Bag-mask ventilation, a common resuscitation technique, involves forcing air into a patient’s lungs. With the help of an oropharyngeal airway, more air can reach the lungs, making the process of resuscitation more effective.
