Airway Adjuncts

Nasopharangeal Airway
Oropharangeal Airway
Laryngeal Mask Airway

Primary Survey - Airway 1

 Nasopharyngeal airway (NPA)

Primary Survey - Airway 2

2
 Nasopharyngeal airway (NPA)

The nasopharyngeal airway is a soft, flexible tube

consisting of three parts: flange, cannula and
bevel/tip.
The flange, at the proximal end, is trumpet-shaped
to prevent the airway slipping into the nasal cavity.
The hollow cannula allows for airflow into the
laryngopharynx, as well as allowing for passage of
a suction catheter.
Bevelled tip allows for ease on insertion and when
inserted correctly, sits posterior to base of the
tongue.
Primary Survey - Airway Presentation title 3
3
 NPA Indication

The patient in an altered conscious state in the

presence of trismus.

Who might this be?

Primary Survey - Airway 4

4
 NPA - Advantages
- Better tolerated than the OPA in the semi-
conscious pt and is less likely to induce vomiting
in pts with an intact gag reflex.
- Able to be used in pts with trismus (clenched
jaws) or dental trauma.
- Rapidly inserted.
- No pre-set age, but length of NPA protruding
from nostril should not be excessive as to be
kinked by the application of the rigid facemask.

Primary Survey - Airway Presentation title 5

5
 NPA - Disadvantages
- May cause epistaxis (nosebleed).
- Smaller internal diameter than OPA.
- May be difficult to suction through.
- Does not isolate trachea.
- May obstruct post insertion.
- Difficult to insert in the presence of nasal
trauma, or established nasal deformity.

Primary Survey - Airway Presentation title 6

6
 NPA Contraindications
1. Middle third facial fracture.
Possibility of introducing the NPA into the brain!
Also risk of infection keep NPA as clean as possible.

2. Significant nasal trauma.

Difficult insertion and Likelihood of making the injury worse.

3. Traumatic brain injury and neurological event where

airway is patent and tidal volume is adequate despite
trismus.
4. Traumatic brain injury and neurological event where
airway is patent and tidal volume is adequate despite
trismus.
Likelihood of eliciting a gag response and subsequently
increasing ICP.

Primary Survey - Airway 7

7
 NPA Precautions
Base of skull fractures and Facial Fractures.
Cerebrospinal fluid (CSF) from nares or ears.
Strong possibility of compromised skull integrity
therefore there is a risk of inserting NPA into brain.
Proper insertion technique however will reduce
chances.

May require removal if view in intubation

attempts are affected.

Primary Survey - Airway Presentation title 8

8
 NPA Sizing Up
1. Nares to the Tragus
2. Check the diameter

Primary Survey - Airway 9

9
 NPA Insertion

Primary Survey - Airway 10

 Oropharyngeal Airway (OPA)

Primary Survey - Airway 11

11
 Oropharyngeal Airway (OPA)
The OPA is a semi-circular shaped airway made of hard
plastic.
The OPA is inserted through the open mouth, over the
tongue, with the tip positioned at the rear of the
oropharynx.
Their use is to simply block the tongue from falling
backwards and occluding the oropharynx
The airway has for parts: flange, body, tip and channel.
The flange protrudes from the pts mouth, resting
against the lips.
The body of the airway covers the tongue.
The channel allows for passage of a suction catheter.
AV uses five different sizes for adults and three for
paediatrics.
Primary Survey - Airway Presentation title 12
12
 Oropharyngeal Airway (OPA)

Primary Survey - Airway 13

13
 OPA - Advantages
- Prevents tongue from falling backwards and
occluding the oropharynx.
- Hard plastic helps to prevent teeth clenching.
- Larger diameter to allow for better oxygenation.

Primary Survey - Airway Presentation title 14

14
 OPA - Disadvantages

- OPA must be measures correctly to avoid either

not working effectively if too small (dont work as
they are intended to) or damaging the soft
posterior structures if too big.

Primary Survey - Airway 15

15
 OPA Indications
- The OPA is only indicated in unconscious pts;
otherwise it is likely to initiate gagging and
vomiting.
- As a bite block to support an endotracheal tube
(to prevent pt biting of the ETT and occluding
this soft tube)

Primary Survey - Airway 16

16
 OPA - Contraindications
- Pts with an intact gag reflex (even a weak one
it should be removed). Gag responses
increase ICP which impact on CPP
- Remember: CPP = MAP ICP

- Pts that have trismus (clenched jaws).

Primary Survey - Airway 17

17
 OPA - Precautions
- Pts with neurological injury (traumatic or
otherwise).
- A pt whos ICP may already be increased, a gag
response will further increase ICP.
- Hence decrease CPP.

Primary Survey - Airway 18

18
 OPA Sizing Up

Primary Survey - Airway 19

19
 OPA Insertion

Primary Survey - Airway 20

20
 LMA - Supraglottic Airway i-gel

Primary Survey - Airway 21

21
22
 LMAi-gel
The LMA forms a low pressure seal around the
posterior perimeter of the larynx and is
positioned superior to the oesophagela
sphincter that enables positive pressure
ventilation.

Primary Survey - Airway 23

23
 i-gel Indication
Unconscious Patient without gag reflex
Ineffective ventilation with BVM (Bag Valve
Mask)/oxysaver and airway Mx (OPA/NPA)
A patient that requires > 10 minutes of assisted
ventilation
Unable to intubate/difficult intubation.

Primary Survey - Airway 24

24
 i-gel - Advantages
Provides an improved airway and ventilation Mx opposed to a
facemask and OPA/NPA.
Although the LMA does not protect against aspiration studies have
shown it to be as low at 3.5% with an LMA compared to 12.4% with a
BVM.
The LMA can be insert in the left or right lateral position, or if the
patient is trapped then LMA can be inserted whilst the patient is
sitting.

Primary Survey - Airway 25

25
 i-gel - Disadvantages

?
If insertion fails and ventilation is difficult or
inadequate, check the position of the cuff using
the larygoscope. If minor
adjustments/repositioning can be made do so.
You get two attempts at inserting an LMA. If
insertion fails on the second attempt then revert
to using a BVM with an OPA/NPA.

Primary Survey - Airway 26

26
 i-gel Contraindications

Intact gag reflex or resistance to insertion

Strong jaw tone and/or trismus
Suspected epiglottitis or upper airway
obstruction
The use of sedation to either assist placement
of , or maintain placement of an LMA.

Primary Survey - Airway 27

27
 i-gel Precautions

Inability to prepare the Pt in the sniffing position

Pts who require high airway pressures, e.g.
advanced pregnancy, morbid obesity, decreased
pulmonary compliance (stiff lungs due to
pulmonary fibrosis), or increased airway
resistance (severe asthma)
Patients < 14 years due to enlarged tonsils
Significant volume of vomit in the airway

Primary Survey - Airway 28

28
 i-gel Sizing Up

Primary Survey - Airway 29

29