It is often difficult to correctly place nasogastric (NG) tube in anesthetised and in ICU patients . We hypothesized that a simple modification in technique of NG tube insertion will improve the success rate.

This is a crossover study wherein 100 patients were enrolled and were randomized into two groups:

Group 1: In the first attempt, patients head was kept in sniffing position and the NG tube inserted. The tube was removed and in the next attempt ng tube was inserted using an additional 1.5 inch pillow to further increase the head flexion.

Group 2: The first attempt was accomplished with increased head flexion i.e., with an additional pillow and the second attempt was done with patient in sniffing position. Following parameters were noted-

1.The time required for successful NG tube placement with either of the technique.

2.Failure rate. Failure of was defined as inability to insert the tube in 2 attempts, use of more than one alternative manoeuvres such as jaw lift, laryngeal lift, direct larygoscpy and magills forceps and time for insertion more than 30 sec.SPSS version 17.0 was used to analyse the success rate of both techniques,, duration of procedure.

Success rates were higher when the NG tube was inserted with the head in further flexion (p<0.000) using an additional pillow in both the groups. The time necessary to insert the NG tube was significantly shorter (p<0.000)when the neck was further flexed.

A simple manoeuvre such as increasing the head flexion improves the success of Nasogastric tube insertion in anesthetised patients.