Oralnasal Airways

The oral airway (Fig 14-2) is an "S"-shaped, rigid instrument used to prevent the base of the tongue from occluding the hypopharynx. It should be used to maintain the airway only in a patient with an absent gag reflex. It can also be used as a bite block during orotracheal intubation. The operator places the oral airway over the tongue, being careful not to push it further into the hypopharynx. A tongue blade can be used to aid insertion. The concave portion is placed cephalad, rotated 180°, or aimed toward the ear and rotated 90° inferiorly to hold the tongue away from the pharyngeal wall.

FIG. 14-2. An oral airway.

A nasal airway (nasopharyngeal tube) (Fig 14-3) is made of a pliable (latex) material that allows it to be placed into the nostril of a somnolent patient with an intact gag reflex. The nasal airway is a wonderful tool that can be quickly placed in a sonorous patient who may have decreased pharyngeal muscle tone and an obstructing soft palate and tongue. It allows air to bypass such obstructions, and if topical anesthesia was used as a lubricant, may ease subsequent passage of a nasogastric tube. The nasopharyngeal tube should be inserted into the most patent nostril (with the tip lubricated, ideally with a topical anesthetic such as lidocaine jelly) horizontal to the palate, and advanced until maximal airflow is heard. It is important to use the correct size tube and to avoid inserting it far enough to stimulate the gag reflex.

FIG. 14-3. Nasal airways.

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