Which airway adjunct is contraindicated in a patient with a gag reflex?

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

Answer: (A)

A gag reflex makes the oropharyngeal airway inappropriate. This device sits in the mouth and back of the throat, so in a patient who can still feel and respond to the throat, inserting it will often trigger gagging, coughing, or vomiting and can lead to aspiration. The gag reflex is what you rely on to protect the airway, so bypassing it with an oropharyngeal airway is contraindicated.

By contrast, a nasopharyngeal airway goes through the nose and is often tolerated in patients with an intact gag reflex, provided there’s no nasal trauma or skull fracture. An endotracheal tube provides a definitive airway and isn’t limited by the gag reflex in the same way, though it requires a controlled procedure. A laryngeal mask airway is typically used when the patient is unconscious; placing it in a patient with an active gag reflex would provoke gagging and is not appropriate.