Oropharyngeal Airway

Towels, sheets, or commercial devices as needed for placing neck and head into sniffing position. Forceps (if needed to remove easily accessible foreign bodies), to clear the pharynx as needed. Nasogastric tube, to relieve gastric insufflation as needed. An oropharyngeal airway used concurrently with a nasopharyngeal airway may improve oxygenation and ventilation. Aligning the external auditory canal with the sternal notch may help open the upper airway and establishes the best position to view the airway if endotracheal intubation becomes necessary. The degree of head elevation that best aligns the ear and sternal notch varies (eg, none in children with a large occiput, a large degree in obese patients). The sniffing position—only in the absence of cervical spine injury. Position the patient supine on the stretcher.

Align the upper airway for optimal air passage by placing the patient into a proper sniffing position. Proper sniffing position aligns the external auditory canal with the sternal notch. To achieve the sniffing position, folded towels or other materials may need to be placed under the head, neck, or shoulders, so that the neck is flexed on the body and the head is extended on the neck. In obese patients, many folded towels or a commercial ramp device may be needed to sufficiently elevate the shoulders and neck. In children, padding is usually needed behind the shoulders to accommodate the enlarged occiput. Position the patient supine or at a slight incline on the stretcher. Avoid moving the neck and use only the jaw-thrust maneuver or chin lift without head tilt to manually facilitate opening of the upper airway. Head and neck positioning to open the airway. The head is flat on the stretcher; the airway is constricted. The ear and sternal notch are aligned, with the face parallel to the ceiling (in the sniffing position), opening the airway.

Step-by-step description of oropharyngeal airway procedure. As necessary, clear the oropharynx of obstructing secretions, vomitus, or foreign material. Determine the appropriate size of the oropharyngeal airway. Hold the airway beside the patient’ s cheek with the flange at the corner of the mouth. The tip of an appropriately sized airway should just reach the angle of the mandibular ramus. Next, begin inserting the airway into the mouth with the tip pointed to the roof of the mouth (ie, concave up). To avoid cutting the lips, be careful not to pinch the lips between the teeth and the airway as you insert the airway. Rotate the airway 180 degrees as you advance it into the posterior oropharynx. This technique prevents the airway from pushing the tongue backward during insertion and further obstructing the airway.

When fully inserted, the flange of the device should rest at the patient’ s lips. Alternatively, use a tongue blade to depress the tongue as you insert the airway with the tip pointed to the floor of the mouth (ie, concave down). Use of the tongue blade prevents the airway from pushing the tongue backward during insertion. Ventilate the patient as appropriate. Monitor the patient and identify and remediate any impediments to proper ventilation and oxygenation. Secure the oropharyngeal airway if it should remain in place (eg, during mechanical ventilation after oral endotracheal intubation).

Acute respiratory failure is caused by a wide range of etiologies. Progression to cardiopulmonary arrest and ultimately death is likely in the absence of effective and timely airway management. Therefore, one of the primary goals of airway management is to provide adequate ventilation and oxygenation to avoid or halt the progression to cardiopulmonary arrest. Effective and timely airway management is also an essential component of successful cardiopulmonary resuscitation. Airway management is critical in the pediatric population as pediatric airway problems are commonly seen in pediatric and general emergency departments.

Initial steps in airway management include airway positioning maneuvers (for example, head-tilt-chin lift, jaw-thrust), suctioning, supplemental oxygen, and re-positioning of the airway if the previous steps are ineffective. Airway positioning maneuvers place the airway in a neutral position and help move the tongue and palatal tissues away from the posterior wall of the pharynx. When choosing an airway positioning maneuver, one must be cognizant of the possible presence or absence of a cervical spine injury. Suctioning assists with the removal of secretions that could be causing or contributing to airway obstruction. If these steps do not help in maintaining a patent airway or in providing adequate ventilation and oxygenation, then an airway adjunct should be utilized. Airway adjuncts are used to relieve or bypass an upper airway obstruction during airway management. However, upper airway obstruction may be present for several reasons, and airway adjuncts may not be able to relieve or bypass all types of obstruction. Upper airway obstruction may occur from anatomical causes such as choanal atresia, pathological causes such as a tonsillar abscess or adverse effects from patient management such as loss of airway patency during the administration of sedation and/or analgesia.

There are also subsets of patients that are more prone to develop upper airway obstruction. Patients with obesity are at significant risk for upper airway obstruction due to altered upper airway anatomy. Pharyngeal tissues have increased fat deposition causing excess upper airway tissue and an increased likelihood of pharyngeal wall collapse resulting in airway obstruction. This can be exacerbated when patients with obesity are given drugs that depress the central nervous system or have other co-morbidities, such as obstructive sleep apnea (OSA) and/or obstructive hypoventilation syndrome (OHS). The presence of OSA and/or OHS can be associated with increased sensitivity to the respiratory depressant effects of sedatives and opioids increasing the tendency to obstruct the airway.

Pediatric patients, in particular infants and young children, are susceptible to upper airway obstruction. This predisposition is due to the differences between pediatric and adult airways. Infants and young children have a relatively large occiput that causes neck flexion when lying supine. This results in a natural tendency to obstruct the upper airway. They have a proportionally large tongue relative to the size of their oral cavity which also causes a natural obstruction of the airway. Additionally, a shortened thyromental distance in this patient population brings the tongue into proximity of the soft palate. Consequently, this leads to obstruction of the airway. Lastly, compared to adults, infants and young children have larger adenoidal tissue, as well as, more distensible and compliant larger airways which predisposes them to airway obstruction. In general, by the age of eight, the pediatric airway is very similar to that of an adult airway.There are two types of airway adjuncts. One is an oropharyngeal airway, and the other is a nasopharyngeal airway.

HangZhou Trifanz Medical Device Co., Ltd is located in the vibrant bio-industrial park of LinPing, Hangzhou. The park enjoys a beautiful environment and convenient transportation. It is adjacent to Shanghai, Ningbo and other important ports. The company is an integrated science and technology innovation enterprise, mainly engaged in the research, development, production and sales of medical catheters in the fields of respiration, anesthesia, and severe diseases. It has its own R&D team: a group of professional and technical personnel with nearly 20 years of experience in the industry; own The production site: 1000 square 100,000 GMP clean workshops; among the company's employees, more than 80% of college and university staff account for the company's production and operation activities in strict accordance with national and international requirements to run the quality management system cloud operation, passed the CE, ISO13485 system certification; can provide OEM / ODM services.