User:Rnr11b/Advanced airway management

Pharyngeal airways
Pharyngeal airway devices are used in spontaneously breathing patients to move the tongue away from the back of the throat to restore airway patentcy. Obstruction of the upper airway caused by the tongue most commonly occurs during times of decreased levels of consciousness. Pharyngeal airway devices include nasopharyngeal airways (NPAs) and oropharyngeal airways (OPAs). These devices are the simplest artificial airways.

Oropharyngeal airways
Main article: Oropharyngeal airway

An oropharyngeal airway (OPA) is a rigid tube that is inserted into the mouth through the oropharynx and placed above the tongue to move it away from the back of the throat. They are more commonly used than nasopharyngeal airways (NPAs). OPAs should only be used in profoundly unresponsive or unconscious patients without a gag reflex. Placement of the device may stimulate the gag reflex and cause vomiting, aspiration, and laryngospasm. Complications from OPA placement include damage to the teeth and the lingual nerve, which may cause changes in taste and sensation of the tongue.

Nasopharyngeal airways
Main article: Nasopharyngeal airway

A nasopharyngeal airway (NPA) is a flexible tube that is passed through the nose into the back of the throat. They are the artificial airways of choice in patients who are conscious and have intact gag reflexes because they are less likely to stimulate the gag reflex than oropharyngeal airways (OPAs). NPAs can also be used in other sitations where OPAs cannot, such as in patients with restricted mouth opening or oral trauma. NPAs are generally not recommended if there is suspicion of a fracture to the base of the skull due to the risk of the tube entering the cranium. They are also contraindicated in the presence of significant facial trauma. Epistaxis is a complication of NPAs that may result from the use of excessive force during placement.

Extraglottic airways
Extraglottic airway devices (EGDs) create a patent airway without entering the trachea. These devices are highly effective for providing oxygenation and ventilation. They can be used as primary airway devices, such as during CPR, or as rescue devices in situations where securing an airway using other devices has failed. EGDs are especially good rescue devices for obese patients and patients with significant facial trauma. EGDs do not protect the trachea from obstruction or aspiration. They may be used for several hours until a definitive airway can be secured.

Each type of EGD has different features, including the ability to remove air from the stomach (gastric decompression) and perform tracheal intubation. All EGDs can be placed without directly seeing the glottis (also called "blind" placement). EGDs can be classified into supraglottic airways and retroglottic airways.

Supraglottic airways
Supraglottic airway devices (SGAs) create a seal over the glottic opening to send oxygen directly into the trachea. The SGAs consist entirely of laryngeal masks. Several manufacturers produce these devices, the most well known being the laryngeal mask airway (LMA). Success rates of SGAs in securing airways are similar between the different models, and these devices provide effective ventilation in more than 98% of patients. SGAs can be placed in under 30 seconds, making them advantageous for emergency use. Serious complications are rare and usually result from nerve and soft tissue trauma in the pharynx during placement.

Retroglottic airways
Retroglottic airway devices (RGAs) pass behind the glottis and into the esophagus to create a seal allowing oxygen to be delivered directly to the trachea. The RGAs are designed as laryngeal tubes. Examples of RGAs include the Combitube and The King LT. Studies comparing the effectiveness between the RGAs are lacking. Like SGAs, most complications from RGAs result from trauma to the pharynx during placement.