In an unconscious patient with gag reflex absent, which airway adjunct is preferred as the first-line option?

• A. Nasopharyngeal airway (NPA).
• B. Laryngeal mask airway (LMA).
• C. Oropharyngeal airway (OPA).
• D. Endotracheal tube.

Answer: (C)

When gag reflex is absent, the priority is to keep the airway open without triggering protective reflexes. An oropharyngeal airway does this by placing a simple tube in the mouth that props the tongue forward and prevents it from occluding the pharynx, creating a clear conduit for air. It’s quick to insert, well tolerated in an unconscious patient, and provides immediate airway patency while you assess and prepare for a more definitive airway if needed. The other options are more invasive or require more time and skill: a laryngeal mask or endotracheal tube offers greater airway control but isn’t first-line in an unresponsive patient because they’re more complex to place and carry higher risk if performed without full readiness. A nasopharyngeal airway could be used in some unconscious patients, but the oral route is preferred when gag reflex is absent due to ease of use and lower risk of nasal trauma.