ABSTRACT :

Insertion of a Nasogastric tube (NGT) in anaesthetised, paralysed and intubated patients can be difficult. But whether the difficulty in NGT insertion is due to collapse of airway subsequent to loss of airway tone or the altered anatomy caused by the endotracheal tube is not well studied. This study was conducted to assess the success rate of insertion of NGT in anaesthetised patients before or after endotracheal intubation. METHODS :

124 patients in the aged 18 to 70 years, requiring general anaesthesia with endotracheal intubation and NGT for various surgical procedures, were included in the study. In after intubation group, NGT insertion was attempted after endotracheal intubation and cuff inflation. If the attempt fails, then subsequent attempts were made with maneuvers as follows: neck neutral, neck flexed and laterally rotated, following endotracheal cuff deflation and finally using laryngoscope. In before intubation group, patients were mask ventilated with 100% oxygen after giving anaesthesia and then NGT insertion was attempted, but before endotracheal intubation. If the attempt fails, then subsequent attempts were made in the sequence as described before. First attempt success rate, number of attempts needed, time taken for NGT insertion were compared

RESULTS :

First attempt success rate was significantly higher when NGT insertion was attempted before rather than after endotracheal intubation. Number of attempts needed, time taken for NGT insertion was also significantly less in before intubation group.

CONCLUSIONS :

In anaesthetised, paralyzed patients, NGT can be inserted safely and much easily if done before endotracheal intubation rather than after endotracheal intubation.