​General Preparation

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1. Assess patient anatomy, including size of the tongue and tonsils.

2. The currently available Airway size is appropriate for average sized men and women. 

3. Position the patient with neck in a neutral or slightly extended position, as appropriate.

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Placement in Patients with Small Tongue

• Use a tongue depressor to open the mouth and visualize the oral cavity.

• With the pharynx visualized, insert the oral airway in the standard fashion (following the natural curvature of the tongue). Adjust mandible to optimize airway position.

 

Placement in Patients with a Large Tongue

• With the Airway in the right hand, grip the visible portion of the tongue at the midline and apply gentle downward and forward pressure to open the mouth — similar in motion to using a laryngoscope.

• With the left hand, insert a tongue blade from the left side of the mouth at an angle to facilitate removal of the Airway and replacement in proper position. 

• Once past the tongue base, withdraw the tongue blade and seat the airway in its final position.

 

In Patients with Large Tonsils

• Rotate the airway 20–30 degrees during insertion:

  • One flange should pass above a tonsil,

  • The other should pass below the opposite tonsil.

• Once the airway tip has passed beyond the tonsils, rotate gently back to the neutral position and seat in place.

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​In patients with Extremely Large Tonsils

• If airway insertion is obstructed by enlarged tonsils:

  • Avoid forcing the airway.

  • Consider alternative airway techniques (e.g., nasopharyngeal airway, supraglottic airway, or advanced airway management).