The Cuffed Oropharyngeal Airway (COPA) Made Simple

The Cuffed Oropharyngeal Airway (COPA) Made Simple

(Originally posted 12 February 2001 on About Anesthesiology)

Introduction
The Cuffed Oropharyngeal Airway (COPA) is a device that was first described by Dr. Robert Greenberg in 1991. It has been marketed since 1997 by Mallinckrodt for use in the United States. It is a supra-glottic airway control device, much like the more popular Laryngeanl Mask Airway (LMA). The COPA consists of a modified Guedel-type airway with an inflatable cuff - which makes placement of the device easy to learn and to teach.

General Description
The device has an integrated bite block, which is color-coded for size and to help with proper positioning. It has a tooth-lip guard and a standard 15mm connector for attachment of circuits, breathing bags, etc. Two posts on the sides of the device are included to attach the elastic fixation strap (also included with each device).

COPA vs. LMA
The use of the COPA is very similar to use of the LMA. Importantly, patient selection is very similar as neither device protects the airway from aspiration risk - and should not be used in patients where this is a concern. As with the LMA, the COPA should be chosen for cases where the patient can remain under anesthesia while breathing spontaneously.

The cost of a single COPA is about $13 per unit. The device is single patient use and is disposable. The single use LMA costs approximately $36 while a reusable LMA-Classic is about $220. Remember, however, that the LMA-Classic also requires processing, cleaning, etc. between each use which adds to the cost of using that device.

Placing and Using the COPA
The COPA currently comes in four sizes (8 - green, 9 - yellow, 10 - red, 11 - light green). Selecting the right size is one of the most important steps of using the COPA. As a guide to choosing the right size, a COPA held next to the patient's head should result in the bite block just above the teeth with the tip of airway at angle of mandible. This is usually one size larger than the corresponding oral airway that would be used in that patient. Choosing the right size is important, as the airway is designed to "lock into place" behind the base of the tongue

Once the right size is chosen, the device should be prepared for use by lubricating it, placing the included strap behind the patients head, testing the cuff, completely deflating the cuff and preoxygenating the patient.

Insertion is facilitated with a dose of Propofol. This dose approximates the usual induction dose. The technique for insertion is the same as insertion of oral airway - either the reverse Guedel technique or the direct Guedel technique may be used. Since most people are already familiar with these techniques, which are already easy to learn, the learning curve for use of this device is not steep.

Once inserted, the device should be strapped into place before any manipulation. This ensures that the COPA will not "pop out" of position with subsequent airway maneuvers. When strapping the COPA in place, make sure that the device is in the midline. If the proper size has been chosen, the colored bite block should "transition" at the teeth.

After strapping the device in place, do a jaw thrust/chin lift. Then inflate the cuff with the proper amount of air:

· Size 8 - 25 cc

· Size 9 - 30 cc

· Size 10 - 35 cc

· Size 11 - 40 cc

Once in place, the following steps should be taken:

· Connect the circuit

· Gentle positive pressure

· Allow return of spontaneous ventilation

· Use "airway maintenance techniques" if needed

Some of the "Airway Maintenance Techniques" suggested by the company to ensure that the COPA works easily are:

· Increased or decreased head tilt

· Turn head to one side

· Support the shoulders

· Gentle chin lift may be needed early in case

· Positive airway pressure up to 10 cm H2O

When the anesthetic is complete, removal of the airway is easy as well. First, allow emergence from anesthesia while leaving the patient relatively undisturbed. Watch for return of airway reflexes - signs of this include swallowing, phonation, etc. Do not deflate the cuff, rather remove the device intact. Any secretions and such will be carried with thte inflated cuff upon removal. Once removed, verify good spontaneous ventilation and airway patency of the patient.

Cuffed Oropharyngeal Airway (Mallinckrodt Medical, Object Number 1)

Cuffed oropharyngeal airway (see Figures 1 to 3) from the Collection of Anesthesia and Intensive Care Medicine at the Institute for the History of Medicine in Vienna (Austria) [catalog number: currently not cataloged]: the airway was manufactured by Mallinckrodt Medical (Athlone, Ireland).
Figure 1: Unclassified metal orpharyngeal airway. Reproduced by courtesy of the Collection of Anesthesia and Intensive Care Medicine at the Institute for the History of Medicine in Vienna (Austria).
Figure 2: Unclassified metal orpharyngeal airway. Reproduced by courtesy of the Collection of Anesthesia and Intensive Care Medicine at the Institute for the History of Medicine in Vienna (Austria).
Figure 3: Unclassified metal orpharyngeal airway. Reproduced by courtesy of the Collection of Anesthesia and Intensive Care Medicine at the Institute for the History of Medicine in Vienna (Austria).

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