Article Contents
Transoral application of a nasopharyngeal airway (NPA) is a novel technique for difficult airway management. Clinically, it is an effective alternative for use in nonintubated dental cases under total intravenous anesthesia. This technique can help improve oxygenation and ventilation in clinical situations in which the conventional use of NPAs is ineffective, such as in patients who have findings of obesity; mandibular retrognathia or hypoplasia; maxillary hypoplasia; macroglossia; nasal obstruction secondary to hypertrophic tonsillar, adenoid, and/or lymphoid tissues or nasal polyps; known unusual nasal anatomy (eg, septal deviation); high risk of prolonged epistaxis (eg, patients on anticoagulants); or those who demonstrate mouth-breathing behaviors during deep sedation/nonintubated general anesthesia. After ensuring proper supraglottic placement, the transorally positioned NPA can be further secured with the use of tape for the duration of the dental procedure. Unlike an oropharyngeal airway, this simple and cost-efficient technique facilitates intraoral access for dental treatment.
Extraoral sizing of an oral placement of a nasopharyngeal airway measured from the angle of the mandible to the labial commissure (marked with a permanent marker).
Oral placement of a nasopharyngeal airway, buccal to a bite-block. Note that the supplemental oxygen line in place only, no capnography sample line, adjustable flange is placed as a reference at the labial commissure.
(a) Setup of cut nasal cannula and EtCO2 sampling line threaded through a 32–34 French NPA. (b) Adjusted nasal cannula threaded through a nasopharyngeal airway without EtCO2 sampling line.
A 4 × 4 cotton gauze throat shield creates a dry, isolated operation field.
Securing the oral placement of a nasopharyngeal airway (O-NPA) near the labial commissure with silk tape. At one end, the silk tape is split in half, lengthwise, up to a midway point. The “legs” of the tape are wrapped around the O-NPA to secure its position. Alternative taping methods similar to those used when securing endotracheal tubes is possible.
Sagittal view demonstrating oral placement of a nasopharyngeal airway (bite-block not shown) and nasal hood setup.
Critical upper airway anatomy and possible placements of the inferior end of an oral placement of a nasopharyngeal airway (regions indicated by “x”).
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eISSN: 1878-7177
ISSN: 0003-3006