
Overview
This module describes how to insert an oropharyngeal airway device (OPA or Guedel airway) to maintain an open airway in a patient with impaired consciousness.
Indications
Impaired consciousness with absent gag reflex (still breathing independently)
Ventilation with a bag valve mask resuscitator
Contraindications
Intact gag reflex
Foreign bodies in the airway — remove foreign body first if possible
Patient information and consent
This procedure is usually done as an emergency measure with an unconscious patient. However, it may be explained to family members afterwards.
How do I explain this procedure?
“I had to put a short tube in the patient’s mouth, into their throat, to keep it open for breathing. This is not uncomfortable for them while they are not awake.”
Preparation
Documentation
Patient notes
Equipment
Non-sterile gloves
A tongue spatula
Oropharyngeal airway devices — keep multiple sizes ready
Site & Positioning
The patient should be lying on their back.
Procedure
Follow medical asepsis with non-sterile gloves.
Perform hand hygiene. Don non-sterile gloves.
Choose the
correct sizecorrect sizeSelecting the correct size is crucial to avoid complications — see Risks.
airway device by placing the tip of the OPA at the angle of the jaw, and pointing the rim towards the central incisors. Choose the size that just reaches the incisors.
Open the mouth and use a tongue spatula to depress the tongue. Insert the airway device and slide the tip over the tongue, following the curve of the tongue and oral cavity, until the rim of the OPA sits just outside the teeth. Be careful not to catch the patient's lip between the rim and the teeth.
Troubleshooting
I think the patient is choking.
Remove the airway device. If the patient is conscious enough to have a gag reflex, the airway device is contraindicated. Consider using an NPA.
The patient is biting down.
Don’t use an OPA as a bite block — provide more sedation and analgesia.
Risks
Vomiting and aspiration
Damage to teeth
Worsening obstruction caused by too short OPA pushing back against the tongue
Laryngospasm caused by too long airway
References
Castro D, Freeman LA. Oropharyngeal Airway. [Updated 2021 Aug 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021. Available from:https://www.ncbi.nlm.nih.gov/books/NBK470198/