When should you not use an oropharyngeal airway?

The use of an oropharyngeal airway (OPA) is contraindicated in patients who have a gag reflex or are conscious because the OPA can provoke a gag response that may lead to vomiting and aspiration. When a patient is conscious, they have the ability to maintain their own airway and can protect it; the presence of a gag reflex indicates that they are capable of airway management on their own. Therefore, inserting an OPA in such patients can be not only uncomfortable but also potentially harmful.

In contrast, the OPA is designed for use in unresponsive patients who do not have a gag reflex, as it can help maintain airway patency by preventing the tongue from occluding the airway. Likewise, in cases of suspected neck injury, careful consideration must be exercised, but utilizing an OPA can still be appropriate if it is determined that the airway needs to be maintained after ensuring spinal precautions. As for patients with difficulty swallowing, it is essential to assess their responsiveness and airway management capabilities before deciding to use an OPA; they may not have a gag reflex if they are not fully alert, which could make the device suitable in certain situations.