How to properly insert an oropharyngeal airway?

An oropharyngeal airway is a simple and quick method to maintain airway patency. Placing an oropharyngeal airway can reduce damage to the oral and airway mucosa, prevent tongue prolapse, and facilitate suctioning. Furthermore, the stimulation of the pharynx during oropharyngeal airway placement can activate the vagus nerve, lowering blood pressure and slowing heart rate, which can be beneficial in the treatment of patients with cerebrovascular accidents. Therefore, knowing how to properly insert an oropharyngeal airway is of great importance!

1. Insertion Procedure
- Select an appropriate oropharyngeal airway.

- Explain the procedure to the patient.
- Lower the head of the bed and assist the patient into a supine position with the head tilted back to align the three axes of the upper airway (mouth, pharynx, and larynx) as much as possible.
- Cleanse oral secretions to maintain a clear airway.
- For unconscious patients, the operator uses the thumb and index finger of one hand to separate the patient's upper and lower teeth, and uses the other hand to insert the oropharyngeal airway from the posterior molars. During the procedure, ensure gentle and precise movements.

- As shown in Figure A, push the oropharyngeal airway downwards along the hard palate until the proximal rim touches the lips, then rotate it 180 degrees. Figure B demonstrates another placement method: using a tongue depressor to hold down the tongue and directly inserting the oropharyngeal airway.
- Test whether the artificial airway is unobstructed.
- Place your palm on the outside of the airway tube to feel for airflow during exhalation, or place a small piece of cotton wool outside the airway tube and observe its movement during breathing. Additionally, observe the range of chest wall movement and auscultate the breath sounds in both lungs.
- Examine the oral cavity to prevent the tongue or lips from being trapped between the teeth and the oropharyngeal airway tube.

2. Classification of methods for inserting oropharyngeal airways
- Direct placement method: The curved end of the airway tube is guided along the surface of the tongue to the upper pharynx, separating the base of the tongue from the posterior wall of the oropharynx. Laryngoscopy can also be used to assist in the insertion.

- Reverse insertion method: Gently insert the oropharyngeal airway into the mouth with the concave side facing upwards, pressing against the tongue. When the tip approaches the posterior pharyngeal wall (having passed the uvula), rotate it 180° so that the concave side faces downwards, and position the tip behind the base of the tongue. Although this method is more difficult to perform, it is more reliable in opening the airway and improving ventilation.

3.Methods for securing an oropharyngeal airway
After successful intubation, the flange of the oropharyngeal airway must be secured to prevent it from slipping into the pharynx or accidentally entering the trachea.

-Traditional method: The oropharyngeal airway is fixed to the patient's upper and lower incisors with two pieces of adhesive tape secured to both cheeks. Disadvantages: The adhesive tape loses its stickiness when wet and is prone to detachment, potentially causing skin allergies or ulceration.

-Improved method: Before intubation, small holes can be made on both sides of the airway flange. A bandage is then threaded through these holes and secured around the back of the neck. This method overcomes the drawbacks of traditional adhesive tape fixation, which is prone to detachment due to moisture, and is more suitable for patients with adhesive tape allergies.

-Common complications: Uvula injury, incisor fracture, pharyngeal bleeding, stress reaction, suffocation, restlessness.

● Maintain a clear airway
Perform timely suctioning to clear the airway and prevent aspiration or even suffocation. Ensure high-flow oxygen is administered before and after suctioning. The suctioning procedure should be gentle to avoid vigorous coughing that could dislodge the oropharyngeal airway.

● Strengthening airway humidification
Covering the outer opening of the oropharyngeal airway with a layer of saline-soaked gauze can humidify the airway and prevent the inhalation of foreign objects and dust. In comatose patients, the oropharyngeal airway can be continuously placed in the oral cavity, but its position should be repositioned every 2-3 hours, and the oral cavity and oropharyngeal tube should be cleaned every 4-6 hours to prevent mucus plugs from blocking the airway.

● Monitoring vital signs
Closely observe changes in the patient's condition, record them regularly, and prepare all necessary rescue equipment and instruments. If the patient's respiratory rate and oxygen saturation progressively decrease or even lead to respiratory arrest after intubation, cooperate with the doctor to carry out relevant rescue procedures.

● Provide proper psychological care.
Before and after inserting the oropharyngeal airway, explain its necessity, function, and possible discomforts to the patient and their family. Conscious patients usually experience significant discomfort when the airway is inserted; therefore, patient explanation and reassurance are crucial to gain their cooperation.