Oropharyngeal Airways in Paediatric Patients

Oropharyngeal airways (OPAs) are useful in maintaining airway patency in unconscious patients of all ages. OPAs are often referred to as a Guedel's airways, after the American physician who developed them. There are some differences in using these in the paediatric population when compared to adults, so here are a few reminders of the differences.

General paediatric airway considerations:

• It is important to have access to a full range of OPA sizes, to ensure the equipment is appropriately sized to the patient. 
• Remove any visible debris and suction vomitus/secretions if necessary, as this keeps the airway clear. 
• Do not perform blind finger sweeps in children, as this can force a foreign body further down the airway and completely occlude at the level of the cricoid ring. 
• Be aware of loose dentition, as school aged children may have loose teeth that can become dislodged in the airway. 

When inserting an OPA in children under 8-years-old:

• Sizing is important: measure from the centre of the incisors to the angle of the mandible
• Use a tongue depressor to assist in insertion: in paediatrics this is needed to ensure the tongue is not pushed back by the oropharyngeal airway 
• Insert the oropharyngeal airway gently: insert under direct vision, putting the oropharyngeal airway in concave side down. This is to avoid damaging the soft palate when rotating the device, using the adult insertion technique.
• Continue to use jaw thrust after insertion, to maximise airway patency
• Hold the head in the appropriate position for the age of the patient: neutral position for infants under 12 months of age, and the slight sniffing position for children aged over 1 year 

If you are interested in updating your knowledge and confidence in paediatric nursing check out our new course, Introduction to Paediatric Nursing. It is designed to increase your confidence when caring for paediatric patients, and enhance your nursing practice. Additionally, you may be interested in attending our Paediatric Advanced Life Support workshops. These workshops utilise a problem-solving approach and are based upon the current Australian Resuscitation Council guidelines. 

• Paediatric Advanced Life Support
• Paediatric Airway Emergencies

For a full list of events and courses please visit https://medcast.com.au/courses. 

References:

Australian and New Zealand Council on Resuscitation (ANZCOR) 2016, ANZCOR Guideline 12.6 – Introduction to Paediatric Advanced Life Support Techniques in Paediatric Advanced Life Support. 

Hambrecht, K. (2019). Cardiopulmonary resuscitation: basic and advanced life support.  Chapter 70 in Brown, D., Edwards, H., Buckley, T., and Aitken, R.L. (eds.). Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems. (5th edn.). Elsevier: Chatswood.

Royal Children’s Hospital Melbourne (RCH) 2019, The Paediatric Trauma Manual: Airway Procedures.