Which airway adjunct should be avoided in a patient with a gag reflex?

• A. Nasopharyngeal airway
• B. Endotracheal tube
• C. Oropharyngeal airway
• D. Laryngeal mask airway

Answer: (C)

When a patient has a gag reflex, you want an airway device that won’t provoke that reflex. The oropharyngeal airway rests in the mouth and sits just behind the tongue, contacting the sensitive posterior pharynx. In an awake patient with a gag reflex, inserting it almost always triggers gagging and possible vomiting, so this device is avoided in such patients.

In contrast, a nasopharyngeal airway passes through the nose and sits above the soft palate, reducing direct contact with the tongue and posterior pharynx, making it better tolerated when gagging is a concern (assuming no nasal injury or skull trauma). Endotracheal tubes and laryngeal mask airways address airway needs through methods that don’t rely on the same oropharyngeal contact, and are used with appropriate sedation or anesthesia, where the gag reflex isn’t a barrier.