Oropharyngeal airway and nasopharyngeal airway_114337 (1).pptx

Airway both oral and nasopharyngeal discussion done

1. Oropharyngeal airway and nasopharyngeal airway Dr Suchismita pal Assistant professor Diamond harbour government medical college

2. Purpose of the oropharyngeal airway

3. 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

4. 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)

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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 This Photo by Unknown Author is licensed under CC BY-SA-NC

14. 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

15. 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)

16. 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

17. 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

18. 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

19. 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

20. 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