OROPHARYNGEAL AIRWAY (OPA) INSERTION

 

The oropharyngeal airway (OPA) is a curved plastic device inserted into the mouth to prevent airway obstruction by displacing the tongue away from the posterior pharyngeal wall. It is a simple but essential airway adjunct used in unconscious patients without a gag reflex to maintain a patent airway.

🚨 Why It’s Important:
✅ Prevents airway obstruction due to tongue relaxation.
✅ Facilitates effective bag-valve-mask (BVM) ventilation.
✅ Ensures continuous airflow in unresponsive patients.

 

1️⃣ HOW THE OPA WORKS

🫁 In unconscious patients, the tongue relaxes and can fall backward, blocking the airway.
🔹 The OPA creates a passage between the tongue and the posterior pharynx, ensuring unobstructed airflow.

🚨 It should NOT be used in conscious or semi-conscious patients due to the risk of gagging and aspiration!

 

2️⃣ INDICATIONS FOR OPA USE

✅ Unconscious patients requiring airway maintenance.
✅ Patients without a gag reflex.
✅ Used during bag-valve-mask (BVM) ventilation.
✅ Temporary airway support before endotracheal intubation.

🚑 Commonly used in cardiac arrest, overdose, and post-seizure management.

 

3️⃣ CONTRAINDICATIONS

🚨 DO NOT use an OPA if any of the following are present:

❌ Conscious or semi-conscious patients

  • Can trigger gagging, vomiting, and aspiration.

❌ Presence of a gag reflex

  • If the patient gags, remove the OPA immediately!

❌ Severe facial trauma

  • May worsen oral injuries or disrupt anatomical structures.

🚨 If an OPA is contraindicated, consider using a nasopharyngeal airway (NPA) instead.

 

4️⃣ SIZING THE OPA

✅ Proper sizing is critical for effective use.

🔹 To determine the correct OPA size:
1️⃣ Measure from the corner of the patient’s mouth to the earlobe or angle of the jaw.
2️⃣ The OPA should be the same length as this measurement.

🚨 If the OPA is too short → It may not prevent airway obstruction.
🚨 If the OPA is too long → It can push the epiglottis over the airway, worsening obstruction.

 

5️⃣ INSERTION TECHNIQUE: HOW TO INSERT AN OPA

✅ Step-by-Step Instructions:

1️⃣ Preparation:

  • Select the correctly sized OPA.
  • Ensure the patient is fully unconscious with no gag reflex.

2️⃣ Opening the Mouth:

  • Use the crossed-finger technique:
    • Place your thumb on the lower teeth and your index finger on the upper teeth.
    • Gently open the jaw.

3️⃣ Initial Insertion (Upside Down Technique):

  • Insert the OPA upside down (curve pointing toward the roof of the mouth).
  • Advance until you meet resistance at the soft palate.

4️⃣ Rotation & Final Placement:

  • Rotate the OPA 180° and advance it until the flange rests against the lips.
  • Ensure the tip rests at the base of the tongue without forcing it down.

🚨 Alternative Method (Tongue Depressor Approach):

  • If difficulty arises, use a tongue depressor to hold the tongue down.
  • Insert the OPA in its final position without rotation.
 

6️⃣ CONFIRMATION OF PLACEMENT

✅ Signs of Proper Placement:
🔹 Unobstructed chest rise with ventilation.
🔹 Clear, open airway with easy bag-mask ventilation.
🔹 No gagging or resistance from the patient.

🚨 Signs of Improper Placement:
❌ Patient gags or vomits → Remove immediately!
❌ Airway obstruction worsens → OPA may be too large or incorrectly positioned.
❌ Snoring-like sounds → OPA may not be fully inserted.

 

7️⃣ COMPLICATIONS & HOW TO PREVENT THEM

 
ComplicationCausePrevention
Gagging & VomitingUsed in a semi-conscious patientEnsure the patient is unconscious before inserting
Oral TraumaForceful insertionInsert gently, rotate smoothly
Airway ObstructionOPA too short or too longUse proper sizing
LaryngospasmIrritation of airway structuresAvoid if gag reflex is present

🚨 If complications occur, remove the OPA and reassess airway management options.

 

8️⃣ IMPORTANT CONSIDERATIONS

🔹 OPA is a temporary airway adjunct – If prolonged airway management is needed, an endotracheal tube (ETT) or supraglottic airway (LMA) should be considered.
🔹 If the patient regains consciousness or starts gagging, remove the OPA immediately!
🔹 Always have suction ready in case the patient vomits.

🚨 The OPA should NEVER be forced—if resistance is met, reattempt using a different size or method.

 

9️⃣ COMPARISON: OPA VS. NPA


FeatureOropharyngeal Airway (OPA)Nasopharyngeal Airway (NPA)
IndicationUnconscious, no gag reflexSemi-conscious, gag reflex present
Insertion RouteMouthNose
Airway Obstruction ReliefPrevents tongue obstructionBypasses soft tissue obstruction
ContraindicationsGag reflex, oral traumaSkull fracture, nasal trauma
Preferred inUnresponsive patients needing BVMPatients needing suctioning or prolonged airway support

🚨 Use an OPA in fully unconscious patients, and an NPA in semi-conscious patients!

 

🔟 FINAL TAKEAWAYS: MASTERING OPA INSERTION

✅ Use the OPA in unconscious patients with no gag reflex.
✅ Measure correctly (corner of mouth → earlobe or jaw angle) to ensure proper sizing.
✅ Insert upside down and rotate 180° to avoid pushing the tongue back.
✅ If gagging occurs, remove immediately and consider an NPA.
✅ Monitor for airway patency and readiness for advanced airway intervention.

🚑 Takeaway: The OPA is a simple yet effective airway adjunct that ensures open airways in unconscious patients. Correct sizing and placement are key to avoiding complications!