Airway adjuncts

Once an open airway has been established, the physician may choose to use either an oropharyngeal or nasopharyngeal airway to make it easier to maintain an open airway. Both of these devices prevent the tongue from occluding the airway and thereby provide an open conduit for air to pass. It is important to note that these two airway devices, unlike a cuffed endotracheal, tube will not protect the trachea from aspiration of secretions or stomach contents. If a patient is unable to protect their own airway, they should have an endotracheal tube inserted as soon as possible by someone who is has specific training and expertise in that skill.

Oropharyngeal airway

The oropharyngeal airway is essentially a curved hollow tube that is used to create an open conduit through the mouth and posterior pharynx. A rough guide for choosing the correct size is to hold the airway beside the patient's mandible, orienting it with the flange at the patient's mouth and the tip at the angle of jaw. The tip should just reach the angle of the jaw. While inserting the airway you want to avoid pushing the tongue into the posterior pharynx. This can be accomplished by starting with the curve of the airway inverted, and then rotate the airway as the tip reaches the posterior pharynx. Alternatively a tongue depressor can be used to move the tongue out of the way as the airway is passed. Whichever technique is chosen the physician must be certain that the airway is indeed in the right position. If there are problems ventilating the patient after insertion of the airway then it should be removed and reinserted.

Nasopharyngeal airway

The nasopharyngeal airway is a soft rubber or plastic hollow tube that is passed through the nose into the posterior pharynx. The tubes come in sizes based on the internal diameter(i.d.) of the tube. The larger the internal diameter the longer the tube. An 8.0 – 9.0 i.d. is used for a large adult, a 7.0 – 8.0 i.d. for a medium adult and a 6.0 – 7.0 i.d. for a small adult. These tubes can be used when the use of an oropharyngeal airway is difficult, such as when a patient is clenching their jaw. As well, the nasopharyngeal airway is generally better tolerated than the oropharyngeal airway in a semiconscious patient. To insert, the nasopharyngeal airway is lubricated with water soluble lubricant or anesthetic jelly along the floor of the nostril into posterior pharynx behind the tongue.