Nasopharyngeal airway for guiding nasogastric tubes: not the best choice.

Abstract

To the Editor: Shetty et al. [1] describe the use of a nasopharyngeal (NP) airway as an obturator for passing a nasogastric (NG) tube, a method previously published [2]. They state that, because the NP airway is only 13.5 cm long, "it is unlikely to enter the cranial vault if there is an unexpected fracture." Muzzi et al. [3], however, have described the entry of a NP airway into the anterior cranial fossa in a patient with a basilar skull fracture [3]. Blind nasal passage of foreign bodies is contraindicated if there is a suspicion of a basilar skull fracture, i.e., facial or cranial trauma, and so a NP airway should not be inserted, as advocated, in every patient [1]. The most common problem encountered in passing a NG tube, in our experience, is that it coils in the oropharynx. This would not be prevented by using a NP airway and would require the use of a Magill forceps under direct laryngoscopy, which can cause trauma to the posterior pharyngeal wall. However, in patients without head injury, this problem may be avoided by blind nasoesophageal intubation rather than NP, as suggested by Chen and Wang [4], using a lubricated, uncuffed, red rubber tube. The NG tube can then be passed down the red rubber tube directly to the esophagus. There is no published evidence to suggest that a NP airway causes any less trauma than a same-sized red rubber tube; nor would we expect it to. Should a nasal approach be contraindicated, then blind oroesophageal intubation may be used with the same effect, which is not possible using a NP airway. Finally, a longitudinally split red rubber tube can be removed from surrounding the NG tube without distortion. It can then be cleaned and reused, a bonus in today's cost-conscious practice. Ratan Alexander, MB, FRCA Joseph A. Cooney, MB, DA Department of Anaesthesia, St. Mary's Hospital, London W2 1NY, United Kingdom