Basic airway adjuncts

In order to keep the open airway maintained, basic airway adjuncts are often useful. These airway adjuncts are designed to prevent soft palate obstruction and prevent the tongue from occluding the pharynx. These may still need to be used in combination with head tilt/ chin lift or jaw thrust maneuver.

Oropharyngeal airway (often called Guedel airway)

A Guedel airway is a curved plastic tube that fits between the tongue and the hard palate. Please watch the video below for correct sizing and insertion technique.

Guedel airways are only appropriate in patients who are unconscious as otherwise they may stimulate the patient to vomit or cause laryngospasm. If the patient shows signs of gagging/ coughing, the Guedel should be removed.

Nasopharngeal airway (NPA)

An NPA is a soft, beveled tube that can be inserted into the nostril to maintain an airway. Unlike the Guedel it can be used in semi-conscious patients who have an intact gag. Please watch the below video for correct sizing and insertion technique.

If the NPA is too long, it may stimulate vomiting or laryngospasm. Conversely if the NPA is too short it will not maintain airway opening. NPA should be avoided in patients with known or suspected base of skull fracture due to risk of insertion into the cranial vault. There is also a risk of bleeding. Caution is advised in patients who have had recent nasal surgery or in those with clotting disorders or being treated with anticoagulants.

Suctioning

If required you can clear the oral cavity using suction with a Yankeur (wide bore rigid sucker). Keep the tip of the yankeur visible at all times, to ensure it is not probing too deep that it might induce a gag reflex. A soft catheter can be used if the patient is unable to open their mouth completely or is biting down.