On the New Nasogastric Tube with Balloon for Prevention of Pulmonary Aspiration of Gastric Contents

Abstract

In Response: We appreciate the interest of Dr. Kubota et al. in our article and thank them for the historical remarks. Unfortunately, we had to omit the interesting history to avoid an excessively long article. At the turn of the century, the pathophysiology of postoperative pneumonitis became a subject of interest among German surgeons [1,2]. As a consequence of the evidence of aspiration as well as regurgitation of infectious material from the oral cavity during general anesthesia, the surgeon Walter Kausch took up the suggestion of his chief, Johann Mikulicz, to develop new concepts for its prevention, especially in situations where patients were suffering from an ileus. As a result of his efforts, Kausch described an inflatable nasogastric tube [3]. Probably, he was inspired by an article by Heinrich Quincke, who, in 1887, described a comparable tube for intestinal flushing as well as obstruction of the intestinal wall in cases of paraplegia [4]. As early as 1913, Kausch's nasogastric tube was described in a German textbook of anesthesia [5]. In 1914, Thomas Jurasz, in an article entitled "A Cardia-Obstructive Tube," praised Kausch's tube "as one of those little technical aids in operative surgery" that have "an immense importance" [6]. He regretted the general lack of knowledge or acceptance of the device by his colleagues and then described a modified inflatable nasogastric tube Figure 1. In 1951, the use of comparable devices for the prevention of aspiration during general anesthesia was discussed again by Sir Robert Macintosh [7]. Perhaps due to his influence worldwide, the concept of such tubes found greater worldwide notice and acceptance. Two years later, Carl Fisher reported on the use of Miller-Abbott tubes [8]. Although the first inflatable nasogastric tube was described 90 years ago, new technical modifications are still being developed, the latest of which is Aspisafe Registered Trademark by the Braun Company.Figure 1: Jurasz's nasogastric tube. Top, Deflated balloon. Bottom, Inflated balloon. (From Munch Med Wschr with permission.)As simple as this principle of cardia blockade may appear today, the technical implementation of the new nasogastric tube presented difficulty owing to the numerous criteria of patient safety that had to be considered. At first, the use of balloon tubes such as the Sengstaken-Blakemore, the Linton Nachlas, or the Miller-Abbott tube was rejected, since these did not offer any definitive protection from regurgitation due to their construction and material. A new nasogastric tube was therefore developed that was designed to ensure safe, continuous apposition of the balloon on the cardia and that can be monitored during the induction and termination of anesthesia. At the same time, it is intended to fulfil the draining function of a conventional stomach tube for reasons of safety and economy. Norbert Roewer, MD Michael Goerig, MD Department of Anesthesiology, University Hospital Eppendorf, D-20468 Hamburg, Germany