Airway both oral and nasopharyngeal discussion done

1. Oropharyngeal
airway and
nasopharyngeal
airway
DR SUCHISMITA PAL
ASSISTANT PROFESSOR
DIAMOND HARBOUR GOVERNMENT MEDICAL COLLEGE

3. Purpose of the oropharyngeal
airway

4.  Purpose : To lift the tongue and epiglottis
from the posterior pharyngeal wall and
prevent them from obstructing the space
above the larynx
 Decrease the work of breathing during
spontaneous breathing when using a face
mask

5. Description:
 Made up of elastomeric material, metal
or plastic
 Parts :
 Flange : at the buccal end / prevents it
from moving deeper in to the mouth
cavity/ helps to fix the airway
 Bite portion: short and firm portion , fits
between the teeth and prevent
occlusion of the airway
 Curved air channel : corresponds with
the shape of the tongue and the palate
 Size: Determined by a number that is
the length in centimeters (American
national standard)

6. Uses
 Helps to maintain an open
airway in an unconscious
person
 Prevents patient from biting an
endotracheal tube
 Protect the tongue from biting
 Facilitate oropharyngeal
suctioning
 Provides a pathway for
inserting devices into the
esophagus and pharynx.
Contraindications
 Intact gag reflex
 Presence of a foreign body
 Active bleeding nose
Complication
 Chances of vomiting
 Inadequate small size -
worsen obstruction by kinking
the tongue and push it against
the roof of the mouth
 Too big size can cause
epicglottis posteriorly and
traumatize the larynx
 Damage to oral structure and
dentition

7. Technique of insertion
 The pharyngeal and laryngeal reflexes should
be depressed
 Correct size estimated by holding the airway
next to the patient’s mouth.
 Lubricate the airway with water base jelly if
possible
 Jaw is opened with the left hand by ‘ crossed
or scissors ‘ technique
 The airway is inserted with the concave side
facing the upper lip
 When the junction of the bite portion and the
curved portion is near the incisors, the airway
is rotated 180º and slipped behind the tongue
into the final position

9. Water airway
 Developed by Ralph M Waters
 Made of metal
 Oval flange, straight bite block and
anatomically curved pharyngeal
portion
 Holes at the distal end
 Not used recently due to higher
chances of damage to teeth and soft
tissue and inability to see any foreign
material lodged inside it

10. Guedel airway
 Single use
 Integrated bite block : coloured
coded according to size
 Smooth bevelled tip for easy
insertion to minimize the trauma
during insertion
 Available in 9 sizes depending o the
distance between the corner of the
mouth and the angle of the jaw
 000, 00, 0, 1 to 6 with length from 40
to 120 mm

11.  Berman airway (Dr Robert Berman)
 Has a centre support and open side
channels along each side that allow a
suction catheter or ETT to slide into the
pharyngeal place
 Better visibility and prevents unseen
occlusion
 Willliams airway intubator (Tudor William
airway)
 Proximal half is cylindrical – maintain tube
in midline
 Distal half is open on the lingual side -
manoeuvrability
 Designed for blind orotracheal intubation/
fiberoptic intubation

12. Patil Syracuse endoscopic airway
 Made from aluminium
(reusable)
 Designed to aid fiberoptic
intubation
 Central groove on the
lingual surface to allow
the fiberscope with a
tracheal tube to pass
 Lateral channel offer
provision of suctioning
 Slit at the distal end
allows the fiberscope to
be manipulated in the AP
direction

13. Ovassapian fiberoptic intubating
airway
 Designed to deliver a
fiberscope as close as
possible to the larynx
 At the buccal end are two
vertical sidewalls and
between them are a pair of
guide walls that curve
towards each other
 Proximal end is tubular- act
as bite block/ distal end is
flat

15. Nasopharyngeal airway
 Resembles a shortened tracheal
tube with a flange at the outer
end to prevent it from
completely passing into the
nares
 When fully inserted the
pharyngeal end remain above
the epiglottis but below the
base of the tongue

16. Uses
 Uses during and after pharyngeal surgery
 To apply continuous positive airway pressure
 To facilitate suctioning and as a guide for nasogastric tube
 As a guide for a fiberoptic and maintaining ventilation during fiberoptic
endoscopy
 To dilate the nasal passages in preparation for nasotracheal intubation
 Used in dental surgery
 Can be fitted with a tracheal tube connector and used with an anesthesia
breathing system

17. Insertion technique
 Diameter of the nasal airway should be the same
as needed for a tracheal tube (0.5 to 1 mm smaller
than for an oral tracheal tube)
 Lubricated thoroughly along its entire length
 Inspect each nostril for size, patency and presence
of polyps
 Use vasoconstrictor drops before insertion
 Airway is held with the bevel against the septum
and gently advanced posteriorly while being
rotated back and forth.
 If resistance is encountered during insertion, the
other nostril should be used or smaller size should
be used
 NPA should be inserted perpendicularly in line
with the nasal passage

19. Linder nasopharyngeal airway
 Made of plastic with a large flange
 Distal end lacks bevel
 Supplied with an introducer which has a
balloon on its tip that can be inflated or
deflated by attaching a syringe to the
one-way valve attached at its end (air of
4-5 ml introduced while inserting to the
approximate dimensions of the outside
diameter of the tube)

20. Cuffed nasopharyngeal tube
 Similar to a short cuffed tracheal tube
 Inserted into the pharynx through the nose and the cuff is inflated and
pulled back unless resistance is felt

21. Binasal airway
 Consists of two nasal airways joined
together by an adaptor for
attachment to the breathing system
 Used to administer anesthesia or to
provide CPAP to babies

22. Contraindications of nasopharyngeal
airway
 Basilar skull fracture/ facial trauma / disruption of midface, nasopharynx or
roof of the mouth
 Pathology or deformity of the nose
 Bleeding disorder or patients taking anticoagulants – high risk of bleeding
 Recent nasal surgery

23. Complications
 Airway obstruction
 Trauma – nose , posterior pharynx
 Central nervous system trauma – nasal airway in basilar skull fracture can
enter the anterior cranial fossa
 Tissue oedema
 Ulceration and necrosis
 Retention, aspiration, swallowing
 Latex allergy
 Gastric distention
 Equipment failure

24. Advantages over oropharyngeal airway
 Better tolerated than an oropharyngeal airway
 Preferable if the patient’s teeth are loose or there is trauma or pathology
of the oral cavity
 Used when the mouth cannot be opened for introducing an oral airway