Nasopharyngeal Airway for Guiding Nasogastric Tubes

Abstract

In Response: We thank Drs. Alexander and Cooney for pointing out the single case report (their ref. 3) in which a patient with multiple facial and skull fractures had a nasopharyngeal (NP) airway placed (not by the authors of the case report) and it partially entered into the anterior cranial vault. This report points out our error in assuming that a NP airway being of short length would not likely enter the cranial vault in a patient with a basilar skull fracture. We hope that this does not distract from the main point--that a small, lubricated NP airway used as an obturator can serve to minimize NP trauma when passing a nasogastric (NG) tube and can aid in directing it toward the esophagus. We have noticed less incidence of curling of NG tubes within the oropharynx since employing this method. The authors of the aforementioned case report advocate using a reusable, longitudinally split, uncuffed red rubber tube as an obturator to assist in passage of the NG tube into the esophagus. They do not specify the size for the adult patient. An 18 Fr NG tube is approximately 7 mm in its greatest diameter. Therefore, a tube of at least 7.5-mm internal diameter would be required. Perhaps this size of red rubber tube would also reduce mucosal trauma as well as ensure easy passage of the NG into the esophagus. However, we suspect that the red rubber tubes are now in extremely short supply in the United States since the introduction of disposable plastic endotracheal tubes several years ago. The cost to restock and to establish a system to reuse them would probably be prohibitive. Therefore, for now the NP airway is the best choice. Randall W. Henthorn, MD Raghuvender Ganta, MD Department of Anesthesiology, The University of Oklahoma Health Sciences Center, College of Medicine, Oklahoma City, OK 73152