The oropharyngeal airway (OPA), often called an oral airway, is a temporary, non-invasive medical device used to maintain an open breathing passage. It is a fundamental component of basic life support, designed to overcome the most common cause of airway obstruction in an unresponsive person. The OPA serves as an adjunct to manual airway maneuvers, creating a clear conduit for air to reach the lungs when a patient is unable to manage their own airway due to a reduced level of consciousness. This device ensures adequate ventilation and oxygenation in emergency situations.
What Is the Oropharyngeal Airway?
The OPA is a rigid, curved piece of plastic, typically manufactured in a J-shape to conform to the natural anatomy of the mouth and throat. It is designed to be disposable and comes in a range of sizes to accommodate patients from infants to adults. Common OPA designs, such as the Guedel or Berman types, feature a flange at the oral end that rests outside the mouth to prevent the device from being inserted too far.
The body of the device includes a reinforced bite block to prevent the patient from biting down and obstructing the passage. The curved design also incorporates a hollow channel or open sides, which allows for the passage of air and provides access for a suction catheter to clear secretions. OPA sizing is determined by external anatomical landmarks, with the general guideline being to measure the distance from the corner of the patient’s mouth to the angle of the jaw.
How the OPA Prevents Airway Obstruction
In a patient who is deeply unconscious, the muscles that control the jaw and tongue relax completely, which is the primary mechanism for upper airway obstruction. The base of the tongue and the epiglottis, a flap of cartilage at the root of the tongue, fall backward to rest against the posterior wall of the pharynx. This mechanical obstruction effectively seals off the opening to the windpipe.
The OPA is specifically engineered to counteract this soft tissue collapse by physically holding the tongue forward and away from the back of the throat. When correctly positioned, the rigid, curved body of the airway device sits over the tongue, displacing it anteriorly. This action creates a clear, unobstructed channel that bypasses the blockage, maintaining a space between the tongue and the posterior pharyngeal wall. The continuous channel provided by the OPA ensures that air can pass freely, which is crucial for both spontaneous breathing and assisted ventilation, such as with a bag-valve-mask.
Situations Requiring OPA Insertion
The OPA is indicated as a first-line intervention in airway management for individuals who are unresponsive and cannot maintain an open airway on their own. This typically involves any situation where a patient’s level of consciousness is severely diminished, leading to the muscular relaxation that causes obstruction. A common scenario is during cardiopulmonary resuscitation (CPR) where manual maneuvers like the head-tilt-chin-lift or jaw-thrust are not sufficient to keep the airway clear.
The device is also frequently used in patients who have experienced an overdose, a severe traumatic brain injury, or respiratory failure that has resulted in deep unconsciousness. Following a seizure, a patient may enter a post-ictal state of unresponsiveness that requires temporary airway support until they recover their protective reflexes. In anesthesia, an OPA may be used during short procedures or in the recovery phase to ensure a patent airway.
Critical Safety and Use Considerations
The primary safety consideration for using an OPA is the absolute necessity that the patient must not have an intact gag reflex. If an OPA is inserted into a patient who is conscious or semi-conscious enough to have this reflex, it can stimulate vomiting. Vomiting in an unconscious patient poses a serious risk because stomach contents can be inhaled into the lungs, a complication known as aspiration, which can be life-threatening.
Proper sizing is also necessary. An OPA that is too short will fail to displace the tongue and may worsen the obstruction. Conversely, a device that is too long can push the epiglottis down or cause trauma to the laryngeal structures, potentially leading to laryngospasm. The insertion of an OPA must be performed by trained medical personnel to ensure the correct technique is used.