Which airway device is appropriate for use in some patients who have a gag reflex but require nasal access?

• A. Endotracheal tube
• B. Nasopharyngeal airway
• C. Oropharyngeal airway
• D. King LT-D

Answer: (B)

A nasopharyngeal airway is designed to be placed through the nose into the nasopharynx, allowing nasal access while keeping the airway open. Because it sits above the soft palate and pharyngeal tissues, it tends to be better tolerated by patients who still have a gag reflex, since it minimizes stimulation of the sensitive posterior tongue and oropharynx that would provoke gagging with an oropharyngeal device. It also allows suctioning through the nasal passages and supports spontaneous breathing.

Important considerations include measuring the correct size (often from the nostril to the earlobe or angle of the jaw), lubricating the tip with a water-soluble lubricant, and inserting gently with the bevel directed toward the septum. It is contraindicated if basilar skull fracture or significant facial trauma is suspected, and it should not be forced if there is resistance or persistent bleeding. The other devices either require mouth insertion (which can trigger gagging) or are intended for a definitive airway and do not offer nasal access.