Abstract
ObjectiveNasogastric tube (NGT) insertion in anesthetized and intubated patients can be challenging, even for experienced anesthesiologists. Various techniques have been proposed to facilitate NGT insertion in these patients. This study aimed to compare the success rate and time required for NGT insertion between GlideScope™ visualization and neck flexion, with lateral neck pressure techniques.Material and methodsThis randomized clinical trial was performed at a teaching hospital on 86 adult patients undergoing abdominal surgery, under relaxant general anesthesia, who required intraoperative NGT insertion. The patients were randomized into two groups, the GlideScope™ group (group G) and the neck flexion with lateral neck pressure group (group F). The success rate of the first and second attempts, duration of insertion, and complications were recorded.ResultsThe total success rate was 79.1% in group G, compared with 76.7% in group F (P = 1). The median time required for NGT insertion was significantly longer in group G, for both first and second attempts (97 vs 42 s P < 0.001) and (70 vs 48.5 s P = 0.015), respectively. Complications were reported in 23 patients (53.5%) in group G and 13 patients (30.2%) in group F. Bleeding and kinking were the most common complications for both techniques.ConclusionUsing GlideScope™ visualization to facilitate NGT insertion was comparable to neck flexion with lateral neck pressure technique, in the degree of success rates of insertion. Although complications were not statistically significant between groups, neck flexion with lateral neck pressure technique was significantly less time-consuming for both first and second attempts.Trial registrationRetrospectively registered: Thai Clinical Trial Registry (TCTR)20171229003. Registered on 19 December 2017
Highlights
Nasogastric tube (NGT) insertion is indicated during many surgical operations for gastric decompression when surgery is performed on the stomach or intestine; it helped prevent aspiration and convenient for surgery in intra-abdomen and used for feeding on perioperative periods [1]
The median time required for NGT insertion was significantly longer in group G, for both first and second attempts (97 vs 42 s P < 0.001) and (70 vs 48.5 s P = 0.015), respectively
Two patients in each group were excluded from this study, on account of no requirement for NGT insertion: one patient in the GlideScopeTM visualization group required an orogastric tube and one patient in the flex neck with lateral neck pressure group needed to control their blood pressure
Summary
Nasogastric tube (NGT) insertion is indicated during many surgical operations for gastric decompression when surgery is performed on the stomach or intestine; it helped prevent aspiration and convenient for surgery in intra-abdomen and used for feeding on perioperative periods [1]. We know it is often difficult to place the NTG in anesthetized, paralyzed, and intubated patients and followed many complications with common injury in the tissue inside the nasopharynx or oropharynx and include wrong placement into the trachea and rarely complication that produced esophageal perforation and pleural cavity penetration but serious complication [1, 2] For that reason, those who could not swallow and have the presence of an inflated cuff in the proximal trachea may cause the gastric tube to become coiled [3]. A study by Appukutty and Shroff reported that flex neck with lateral neck pressure was an easy method with a high success rate in the first and second attempt 94% [9] Visualizationaided devices, such as the Pentax Airway Scope AWS5100 [14], GlideScopeTM visualization [15], and McGrath video laryngoscope [4], were focused on the role of facilitating NGT insertion. It provides a direct view of the larynx during insertion that could confirm the NGT was placed in the esophagus, not in the trachea [16]
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