Beware of Lung Complications When Using Guidewire-Assisted Nasogastric Tube Insertion

Abstract

To the Editor We agree with Kirtania et al.1 that using a Savary-Gilliard (SG) guidewire along with gentle manual forward displacement of the larynx increases the likelihood for success of nasogastric tube (NGT) insertion in anesthetized and tracheally intubated patients. Since 2006, we have used an SG guidewire whenever the patients require insertion of an NGT under general anesthesia.2 We have 13 operating rooms and perform approximately 800 operations every month, one third to half of which require insertion of an NGT. We have an SG guidewire in each operating room and reuse them after proper sterilization. However, there are several differences between the technique and results of Kirtania et al. and our experience. First, we do not alter the handle of the SG guidewire. Rather than keeping it inside the sheath, we store it to maintain its intrinsic curvature. Second and in contrast to Kirtania et al.,1 who report an absence of serious complications, during the 7 years of its use, we have seen 11 cases of lung-related complications including placing the NGT into the trachea near the carina or bronchi (5 cases), pneumothorax (3 cases), and carinal bleeding (3 cases). Two of these cases required treating a pneumothorax using chest tube drainage during anesthesia. We therefore recommend using a method such as ultrasonography3 to confirm placement of the NGT guidewire assembly as well as to detect the presence of complications such as pneumothorax. Ho Sik Moon, MD Department of Anesthesiology and Pain Medicine The Catholic University of KoreaCollege of Medicine Seoul, South Korea Jong-Man Kang, MD, PhD Department of Anesthesiology and Pain Medicine Kyung Hee University Hospital at Gangdong Seoul, South Korea Jin Young Chon, MD, PhD Department of Anesthesiology and Pain Medicine The Catholic University of Korea College of Medicine Seoul, South Korea [email protected]