//Oropharyngeal Airways
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Oropharyngeal Airways
An infant's tongue is relatively large in proportion to the oropharynx and may contribute to obstruction of the
airway during induction of anesthesia or loss of consciousness due to any cause. An oropharyngeal airway (or
laryngeal mask airway [LMA]) of appropriate size may be used to achieve unobstructed air exchange. By
holding the oral airway as shown in Figure 12-13 one can estimate the appropriate size; airways one size larger
and one size smaller should be readily available. A tongue depressor may be used to facilitate insertion of the
oral airway by preventing folding of the tongue, which may impair venous and lymphatic drainage, cause
macroglossia, and thereby cause airway obstruction. If the airway is too long, its tip may push the epiglottis into
the glottic aperture, causing traumatic epiglottitis, or the tip may impinge on the uvula, causing uvular swelling
and airway obstruction (Fig. 12-13C, D).[112,][113] If the airway is too short, it may rest against the base of the
tongue, forcing it posteriorly against the roof of the mouth and thus further aggravating airway obstruction (Fig.
12-13E, F). Oral airways should not be considered panaceas for upper airway obstruction. Care must be taken
to avoid trauma to the lips and tongue, which may be caught between the teeth and the flange of the airway. An
oral airway is also used to protect an oral ETT from compression by a child's teeth, and it can facilitate
oropharyngeal suctioning.
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//Oropharyngeal Airways
http://www.expertconsultbook.com/expertconsult/b/book.do?m...
Figure 12-13 Correct airway selection. An artificial airway of proper size should relieve airway obstruction secondary to the tongue
without damaging laryngeal structures. The appropriate size can be estimated by holding the airway against the child's face; the tip of
the airway should end just cephalad to the angle of the mandible (A). This should result in proper alignment with the glottic opening
(B). If too large an oral airway is inserted; the tip lines up posterior to the angle of the mandible (C) and obstructs the glottic opening by
pushing the epiglottis down (D, arrow). If too small an oral airway is inserted; the tip lines up well above the angle of the mandible (E);
airway obstruction is thus exacerbated by kinking the tongue (F, arrows).
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