Oro- and Nasogastric Tube Passage in Intubated Patients 

1999 ◽  
Vol 91 (1) ◽  
pp. 137-143 ◽  
Author(s):  
Steven Ozer ◽  
Jonathan L. Benumof
Keyword(s):  
General Anesthesia ◽  
Nasogastric Tube ◽  
Gastric Tube ◽  
Average Distance ◽  
Arytenoid Cartilage ◽  
Lateral Neck ◽  
Piriform Sinus ◽  
Thyrohyoid Membrane ◽  
First Pass ◽  
Neck Pressure

Background Insertion of a gastric tube (GT) in anesthetized, paralyzed, and intubated patients can be difficult The purpose of this study was to determine fiberoptically why GTs succeed or fail to enter the esophagus and, based on these findings, to determine a mechanism for converting failures into successes. Methods Sixty patients under general anesthesia and orotracheally intubated were studied. The larynx and hypopharynx of each patient were viewed via a fiberscope placed through the left naris. GTs were passed orally (OGT) and nasally (NGT) in all patients, and the pathway of passage or site of resistance was visualized. In cases of resistance, medially directed ipsilateral neck pressure was applied over the lateral thyrohyoid membrane (termed lateral neck pressure) to try to allow passage of the GT. Results All 60 patients had both an OGT and NGT passed for a total of 120 attempts. The GT passed easily on the first attempt in 92 of 120 insertions (77%) (for OGT 51/60 = 85% and for NGT 41/60 = 68%, P < 0.05). In 92% of these first-pass successes, the GT entered the hypopharynx just lateral to the arytenoid cartilages. The GT met resistance and failed to pass in 28 of 120 insertions (23%) (for OGT 9/60 = 15% and for NGT 19/60 = 32%). The sites of impaction were the piriform sinuses (13/28 = 46%), arytenoid cartilages (7/28 = 25%), and trachea (6/28 = 21%), and two OGTs did not pass the oropharynx (2/28 = 70%). Lateral neck pressure was attempted 20 times (for the piriform sinus and arytenoid cartilage impactions) with 17 successes (85%) and three failures (15%). The average distance to passage of the OGT and NGT by the arytenoid cartilage was 13.2 and 16.2 cm, respectively. Conclusion GTs enter the hypopharynx just lateral to the arytenoid cartilages. Consequently, the most common sites of resistance at the laryngeal level are the arytenoid cartilages and piriform sinuses. Lateral neck pressure compresses the piriform sinuses and moves the arytenoid cartilages medially, relieving 85% of these GT impactions.

scholarly journals Comparison of GlideScope™ visualization and neck flexion with lateral neck pressure nasogastric tube insertion techniques in anesthetized patients: a randomized clinical study

Trials ◽  
2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Pitchaporn Purngpipattrakul ◽  
Suttasinee Petsakul ◽  
Sunisa Chatmonkolchart ◽  
Kanjana Nuanjun ◽  
Somrutai Boonchuduang
Keyword(s):  
Clinical Trial ◽  
Success Rate ◽  
Nasogastric Tube ◽  
Lateral Neck ◽  
Neck Flexion ◽  
Success Rates ◽  
Clinical Trial Registry ◽  
Randomized Clinical Study ◽  
Time Required ◽  
Neck Pressure

Abstract Objective Nasogastric tube (NGT) insertion in anesthetized and intubated patients can be challenging, even for experienced anesthesiologists. Various techniques have been proposed to facilitate NGT insertion in these patients. This study aimed to compare the success rate and time required for NGT insertion between GlideScope™ visualization and neck flexion, with lateral neck pressure techniques. Material and methods This randomized clinical trial was performed at a teaching hospital on 86 adult patients undergoing abdominal surgery, under relaxant general anesthesia, who required intraoperative NGT insertion. The patients were randomized into two groups, the GlideScope™ group (group G) and the neck flexion with lateral neck pressure group (group F). The success rate of the first and second attempts, duration of insertion, and complications were recorded. Results The total success rate was 79.1% in group G, compared with 76.7% in group F (P = 1). The median time required for NGT insertion was significantly longer in group G, for both first and second attempts (97 vs 42 s P < 0.001) and (70 vs 48.5 s P = 0.015), respectively. Complications were reported in 23 patients (53.5%) in group G and 13 patients (30.2%) in group F. Bleeding and kinking were the most common complications for both techniques. Conclusion Using GlideScope™ visualization to facilitate NGT insertion was comparable to neck flexion with lateral neck pressure technique, in the degree of success rates of insertion. Although complications were not statistically significant between groups, neck flexion with lateral neck pressure technique was significantly less time-consuming for both first and second attempts. Trial registration Retrospectively registered: Thai Clinical Trial Registry (TCTR)20171229003. Registered on 19 December 2017

Comparison of the GlideScopeTM Visualization and Neck Flexion with Lateral Neck Pressure Nasogastric Tube Insertion techniques in Anaesthetized Patients: A Prospective Randomized Clinical Study

2020 ◽  
Author(s):  
Pitchaporn Purngpipattrakul ◽  
Suttasinee Petsakul ◽  
Asst. Prof. Sunisa Chatmonkolchart ◽  
Somrutai Boonchuduang ◽  
Kanjana Nuanjun
Keyword(s):  
Success Rate ◽  
Nasogastric Tube ◽  
Lateral Neck ◽  
Neck Flexion ◽  
Tube Insertion ◽  
Randomized Clinical Study ◽  
Insertion Techniques ◽  
Time Required ◽  
Neck Pressure ◽  
Nasogastric Tube Insertion

Abstract Background Nasogastric tube (NGT) insertion in anaesthetized and intubated patients can be challenging even for experienced anesthesiologists. Various techniques have been proposed to facilitate NGT insertion in these patients. This study aimed to compare the success rate and time required for NGT insertion between the GlideScope TM visualization and neck flexion with lateral neck pressure techniques. Methods This randomized clinical trial was performed at a teaching hospital on 86 adult patients undergoing abdominal surgery under relaxant general anaesthesia who required intraoperative NGT insertion. The patients were randomized into two groups, the GlideScope TM group (group G) and the neck flexion with lateral neck pressure group (group F). The success rate of first and second attempts, duration of insertion, and complications were recorded. Results The total success rate was 79.1% in Group G compared with 76.7% in Group F (P=1) The median time required for NGT insertion was significantly longer in Group G, for both first and second attempts (97 vs 42 seconds P<0.001) and (70 vs 48.5 seconds P=0.015), respectively. Complications were reported in 23 patients (53.5%) in group G and 13 patients (30.2%) in group F. Bleeding and kinking were the most common complications in both techniques. Conclusions Using GlideScope TM visualization to facilitate NGT insertion was comparable to neck flexion with lateral neck pressure technique in degree of success rate of insertion and complications were not statistically significant between groups, while neck flexion with lateral neck pressure technique was less time-consuming significantly both first and second attempts.

scholarly journals Application of Modified Gastric Tube Placement in Patients with Indwelling Gastric Tube

2021 ◽  
Vol 5 (6) ◽  
pp. 84-88
Author(s):  
Hua Tang
Keyword(s):  
Pain Score ◽  
Nasogastric Tube ◽  
Research Group ◽  
Gastric Tube ◽  
Reference Group ◽  
Mucosal Injury ◽  
Tube Placement ◽  
Study Group ◽  
Liquid Spray ◽  
Nasogastric Tube Placement

Objective: To explore the effect of modified nasogastric tube placement and Rehabilitation New Liquid Spray in patients with indwelling gastric tube. Methods: Eighty-six cases with indwelling gastric tube in our hospital from January 2020 to May 2021 were randomly selected and divided into the reference group and the research group. The reference group was treated by modified gastric tube placement, and the research group was given the Rehabilitation New Liquid Spray intervention. The effect of the interventions on two groups was observed. Results: The incidence of nasal mucosal injury in the research group was lower than that in the reference group, and the incidence of pharyngeal mucosal injury in the research group was lower than that in the reference group (P < 0.05). The pain score of the study group was lower than that of the reference group at 8 h, 12 h and 24 h after replacement, and the incidence of hoarseness, swallowing discomfort and dry oropharynx was lower than that of the reference group (P < 0.05). Conclusion: The application of modified gastric tube placement and Rehabilitation New Liquid Spray intervention in patients with indwelling gastric tube can effectively reduce the nasopharyngeal injury and improve the pain of catheterization.

Successful Surgical Treatment of a Suspected Iatrogenic Arytenoid Cartilage Fracture in a Dog

2009 ◽  
Vol 45 (4) ◽  
pp. 181-184 ◽  
Author(s):  
Ivan Doran ◽  
Robert N. White
Keyword(s):  
Surgical Treatment ◽  
General Anesthesia ◽  
Sudden Onset ◽  
Arytenoid Cartilage ◽  
Golden Retriever ◽  
Intact Female ◽  
Laryngeal Examination

A 3-year-old, intact female golden retriever was presented with a sudden onset of inspiratory obstructive dyspnea following general anesthesia to perform a mastectomy. The cuneiform process of the left arytenoid cartilage was found to be extremely mobile on laryngeal examination. Fracture of the cuneiform process of the left arytenoid cartilage was diagnosed. A combined cricoarytenoid and thyroarytenoid caudolateralization procedure was performed on the left side, and no further dyspnea was observed during a follow-up period of 7 months. Fracture of the cuneiform process of the arytenoid cartilage has not been previously reported in dogs. The condition may respond favorably to cricoarytenoid and thyroarytenoid caudolateralization surgery.

scholarly journals The GlideScope with modified Magill forceps facilitates nasogastric tube insertion in anesthetized patients: A randomized clinical study

2018 ◽  
Vol 46 (8) ◽  
pp. 3124-3130 ◽  
Author(s):  
Han Joon Kim ◽  
Su In Park ◽  
Sang Yun Cho ◽  
Min Jae Cho
Keyword(s):  
General Anesthesia ◽  
Success Rate ◽  
Nasogastric Tube ◽  
Insertion Time ◽  
Control Group ◽  
Magill Forceps ◽  
Randomized Clinical Study ◽  
Experimental Group ◽  
Control Group Group

Objective Insertion of a nasogastric tube (NGT) in patients who have been intubated with an endotracheal tube while under general anesthesia can cause difficulties and lead to complications, including hemorrhage. A visualization-aided modality was recently used to facilitate NGT insertion. Some studies have focused on the role of modified Magill forceps, which have angles similar to those of the GlideScope blade (Verathon, Bothell, WA, USA). Methods Seventy patients were divided into a control group (Group C) and an experimental group (GlideScope and modified Magill forceps, Group M). Results The total NGT insertion time was significantly shorter in Group M than C (71.3 ± 22.6 vs. 96.7 ± 57.5 s; mean difference, –25.3 s; 95% confidence interval [CI], 20.8–71.5). There were also significantly fewer mean insertion attempts in Group M than C (1.0 ± 0.0 vs. 2.11 ± 0.93). The success rate for the first attempt in Group C was 37.1%, while that in Group M was 100% (relative risk, 2.7; 95% CI, 1.7–4.1). Conclusion The use of the GlideScope with modified Magill forceps for insertion of an NGT in patients who are already intubated and under general anesthesia will shorten the insertion time and improve the success rate.

scholarly journals One Case of Esophageal Obstruction Caused by Enteral Nutrition

2021 ◽  
Vol 2 (2) ◽  
Author(s):  
Yangzhong Wang ◽  
Xiuqing Liao ◽  
Xiaoli Bao ◽  
Xianlin Peng ◽  
Nan Tang
Keyword(s):  
Mechanical Ventilation ◽  
Enteral Nutrition ◽  
Sodium Bicarbonate ◽  
Nasogastric Tube ◽  
Gastric Tube ◽  
Foreign Bodies ◽  
Severe Pneumonia ◽  
Endoscopic Removal ◽  
Esophageal Obstruction ◽  
Severe Respiratory Distress

We report a case of complete esophageal obstruction caused by continuous enteral nutrition infusion via nasogastric tube. A 77 year old man received mechanical ventilation due to severe pneumonia and severe respiratory distress. He began using enteral nutrition emulsion (TPF) through a nasogastric tube on admission. 15 days later, due to the difficulty of re-inserting the nasogastric tube, endoscopy found a large number of coagulations in the esophagus, resulting in complete esophageal obstruction. We remove a small part of the foreign body with a net basket under gastroscope. After the operation, the nasogastric tube was placed in the middle of the esophagus again, which was perfused with 5% sodium bicarbonate and vinegar through the gastric tube. One week later, the esophagus was completely unobstructed by gastroscopy. A conclusion can be drawn that the precipitation and coagulation of TPF can lead to the whole esophageal obstruction. Endoscopic removal of foreign bodies, sodium bicarbonate and vinegar retention in the esophagus can treat the food obstruction caused by TPF.

scholarly journals Cervical Fracture with Piriform Sinus Laceration

2021 ◽  
Vol 26 (1) ◽  
pp. 34-35
Author(s):  
Mihaela Chialda
Keyword(s):  
Conservative Treatment ◽  
Contrast Agent ◽  
Broad Spectrum ◽  
Nasogastric Tube ◽  
Cervical Fracture ◽  
Broad Spectrum Antibiotic ◽  
Cervical Trauma ◽  
Piriform Sinus ◽  
Delayed Onset ◽  
Zone Ii

Abstract Particular case of complex cervical trauma by associating a cervical fracture with piriform sinus laceration. The trauma is located in the anatomo-topographic zone II. Delayed onset at 24 hours of digestive symptoms, swallowing disorders, sialorrhea, dysphagia, subcutaneous cervical emphysema. CT with Optiray contrast agent is performed, an investigation that reveals a gap in the left piriform sinus of 5-6 mm. The evolution is favourable under conservative treatment, nasogastric tube, broad spectrum antibiotic treatment.

scholarly journals Piriform sinus fistula as a cause of lateral neck abscess.

1991 ◽  
Vol 42 (1) ◽  
pp. 40-43
Author(s):  
Toru Takimoto ◽  
Tomokazu Yoshizaki ◽  
Hiromi Ohoka ◽  
Hideo Sakashita
Keyword(s):  
Lateral Neck ◽  
Piriform Sinus ◽  
Neck Abscess ◽  
Piriform Sinus Fistula

scholarly journals Nasogastric Tube Knotted Around a Nasal Endotracheal Tube in the Nasopharynx: Possible Cause

2021 ◽  
Vol 68 (2) ◽  
pp. 90-93
Author(s):  
Yunosuke Okada ◽  
Hanako Ohke ◽  
Hiroyo Yoshimoto ◽  
Misato Kobashi ◽  
Masato Saitoh ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Endotracheal Tube ◽  
Nasogastric Tube ◽  
Dental Treatment ◽  
Oral Surgery ◽  
Simple Procedure ◽  
Possible Cause

A nasogastric tube is often used along with a nasal endotracheal tube during oral surgery or dental treatment under general anesthesia. Although the insertion of a nasogastric tube is a simple procedure, it can be associated with complications that lead to potentially serious consequences. The knotting of a nasogastric tube around an endotracheal tube is rare. Here, we report a case in which the nasogastric tube became knotted around the nasal endotracheal tube in the nasopharynx. We compare this case with 4 previous similar cases and provide a theory of how the nasogastric tube might have become knotted.

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