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How to size and insert and OP airway adjunct: Where, When and How?


This video demonstrates how to size and insert an OP airway adjunct and points out relevant airway anatomy. A summary, showing OP airway insertion only, is available on our YouTube channel. For more videos like this, stay tuned to as well as the YouTube, Facebook and Twitter pages.


0:07 disclaimer

0:24 anatomy

1:04 When?

1:14 How? Sizing

1:54 Insertion

2:26 References



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Remember hand hygiene, bare below the elbows, and gloves in real life! (AACE, 2016)

Airway adjuncts ‘prevent the tongue from partially or completely obstructing the airway’ (Anaesthesia UK, 2010).

The key parts of the upper airway for this video concern the nasal cavity, the oral cavity, the hard palate, the soft palate (at the back of the mouth), the oropharnyx and the pharynx, which is a ‘muscular membranous channel’ (QA International, 2017) that ‘begins at the base of the skull’ and ‘connects the nasal cavities to the […] oesophagus’ (Pazhaniappan, 2017). It is made up of the nasopharynx, oropharynx, and laryngopharynx (Pazhaniappan, 2017). It is also the location a correctly sized OP airway should sit in.

Use an OP airway on ‘an unresponsive patient’ who does not have a gag reflex (Pilbery & Lethbridge, 2016).

Having opened the airway using manual airway manouvres and checking it is clear of obstruction, now size the adjunct (Pilbery & Lethbridge, 2016). OP airways range from size 000 to 5 (AACE, 2016). To find the right size, measure ‘the vertical distance between the patient’s incisors and the angle of the jaw’ (Pilbery & Lethbridge, 2016), as shown. The flange (Beattie, 2005) should align with the lips and ‘the tip to the angle of the jaw’ (Anaesthesia UK, 2017). When correctly fitted, the OP airway should be just big enough to have the flange (Beattie, 2005) resting over the patient’s lips. Now insert the adjunct back to front (Pilbery & Lethbridge, 2016) with the bendy part, named ‘the body’ (Beattie, 2005), curved towards the patient’s upper lip and nose. Once the adjunct has reached the soft palate, rotate it 180 degrees and advance it (Pilbery & Lethbridge, 2016). It should now rest in the pharynx (Pilbery & Lethbridge, 2016).

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Anaesthesia UK, 2010. Guedal Airway, Available Online:… (Accessed 22/08/2017)

Association of Ambulance Chief Executives (AACE). 2016. UK Ambulance Services Clinical Practice Guidelines 2016, Bridgwater: Class Professional Publishing

Beattie, S. 2005. Placing an oropharnygeal airway, Available Online:… (Accessed 18/05/17)

Pazhaniappan, N. 2017. The Pharynx, Available Online:… (Accessed 22/08/17)

Pilbery, R. and Lethbridge, K. 2016. Ambulance Care Practice, Bridgwater: Class Professional Publishing QA International, 2017. Respiratory System, Available Online:… (Accessed 22/08/17)


Dobroide, 2010. 20091229.ambulance.siren.wav. Available Online:… (Accessed 21/08/17)


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Final note.

Why is it so important to size the adjunct? Because ‘If the airway [device] is too long it may occlude the airway by […] displacing the epiglottis; if too short it will not separate the soft palate or tongue from the posterior wall of the pharnyx’

Gregory, P. & Mursell, I. 2010. ‘Airway management’ in Manual of Clinical Paramedic Procedures, Sussex: Blackwell Publishing, pp. 2-34

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