LAUSR

Insertion of a nasogastric tube (NGT) in an anaesthetised, intubated patient can become challenging. The conventional method of blind NGT insertion has a success rate of approximately 40–58%.[1] After obtaining patients’ consent and ethical clearance, we selected 20 anaesthetised, intubated patients posted for surgery (1st to 31st January 2022). Patients who needed general anesthesia with intubation and NGT placement (laparoscopic surgery, gastrointestinal surgery, etc.) were included in our study. Patients with skull base fracture, coagulopathy, nasopharyngeal and oesophageal pathology, and head and neck radiotherapy were excluded. Size 16 French, 105 cm NGT was used. NGT insertion was performed by a single anaesthesiologist. After intubation, the head was kept in a neutral position using an intubation pillow (8–10 cm height soft pad placed under the occiput). NGT length was estimated by measuring the distance from the xiphoid process to the nostril via the earlobe. The proximal end of the NGT was lubricated with water-based jelly and inserted through the larger nostril. Once NGT entered the nasopharynx, it was gently inserted further and simultaneously rotated in a clockwise direction continuously using the right hand. The remaining length of the NGT was straightened with its distal end held with the left hand and rotated continuously in the same direction so that the NGT rotates in toto. If any resistance was faced, the NGT was withdrawn a little and reinserted with continuous clockwise rotational movements. Correct placement of NGT was confirmed with epigastric auscultation. Time taken for NGT insertion was noted. A laryngoscopy was done to look for kinking of NGT or bleeding in the oral cavity. If the first attempt failed, NGT was cleaned and reinserted by a similar technique. Time taken for the second attempt of NGT insertion was noted. It was considered as failed, after the failed second attempt. NGT insertion was then guided by laryngoscope and Magill forceps.