Airway - Oropharyngeal airway
Upper airway obstruction requiring airway manoeuvres
Reduced left of consciousness
Contraindications (absolute in bold)
Laryngeal mask airway
Consent is not required
Failure to open airway
Vomiting (if gag reflex intact)
Airway obstruction (if incorrect placement causing posterior displacement of tongue)
PPE: non-sterile gloves, surgical mask, protective eyewear or shield
Oropharyngeal airway (sized from corner of the patient’s mouth to tip of the earlobe)
Neck flexion with atlanto-occipital extension (sniffing position), or
Neck in neutral position with spinal immobilisation (cervical injury suspected)
Head-tilt chin-lift or jaw thrust applied
In adults the sniffing position is achieved by elevating head approximately 10cm while tilting the head posteriorly. This achieves horizontal alignment of the sternum and external auditory meatus. Small children do not require head lift and infants will require slight elevation of the shoulders due to a relatively large occiput.
Open the patient’s mouth with your thumb and index finger
Insert the inverted airway along the patient’s hard palate
Advance posteriorly until distal end entering hypopharynx, then rotate 180 degrees
Use a jaw thrust to aid passage if required
Advance until the flared external tip is as the oral orifice
Use definitive airway management if required
Oropharyngeal airways prevent the base of the tongue from obstructing the airway
When inserting an OPA, the clinician must avoid pushing the tongue into the posterior pharynx
Too small a device is ineffective, too large a device can press against the epiglottis obstructing the larynx
Nasopharyngeal or oropharyngeal airways should be considered with all bag-mask ventilation
A tongue depressor can be used to move the tongue out of the way and pass the airway (instead of inverted insertion and rotation). This method may be considered with suspected oral or palate injury. It is generally not necessary.
This guideline has been reviewed and approved by the following expert groups:
Emergency Care Institute
Please direct feedback for this procedure to ACI-ECIs@health.nsw.gov.au.
Australian Resuscitation Council and New Zealand Resuscitation Council. ANZCOR guideline 11.6 – equipment and techniques in adult advanced life support. Melbourne: Australian Resuscitation Council and New Zealand Resuscitation Council; 2016. 16pp. Available from https://resus.org.au/guidelines/
Roberts JR, Custalow CB, Thomsen TW. Roberts and Hedges' clinical procedures in emergency medicine and acute care. 7th ed. Philadelphia, PA: Elsevier; 2019.
Dunn RJ, Borland M, O'Brien D (eds.). The emergency medicine manual. Online ed. Tennyson, SA: Venom Publishing; 2019.
Wittels KA. Basic airway management in adults. In: UpToDate. Waltham (MA): UpToDate. 2019 Sept 17. Retrieved March 2019. Available from: https://www.uptodate.com/contents/basic-airway-management-in-adults