The Institute of Post-Graduate Medical Education and Research, Kolkata, India.
Anesth Analg. 2012 Feb;114(2):343-8. doi: 10.1213/ANE.0b013e31823be0a4. Epub 2011 Nov 21.
Nasogastric tube (NGT) insertion is indicated almost routinely in patients undergoing abdominal surgery to decompress the stomach intraoperatively and postoperatively, and to allow postoperative tube feeding. NGTs are made of nonreinforced polymer plastic materials and are prone to kinking and coiling during insertion. This often poses difficulty in blind NGT placement or placement assisted by variously described techniques. We hypothesized that esophageal guidewire-assisted NGT insertion with manual forward laryngeal displacement can significantly improve the first-attempt success rate over the technique of head flexion and lateral neck pressure during its insertion in anesthetized and tracheally intubated patients.
Four hundred eighty adult patients presenting for abdominal surgery under general anesthesia with neuromuscular relaxation were randomized to an experimental technique of esophageal guidewire with manual forward displacement of the larynx (group 1) or a control technique of head flexion and lateral neck pressure (group 2) for insertion of the NGT. The success rates (and failure rate) of the first and second attempts (and overall) were assessed along with the incidence of coiling and kinking of the NGT, procedure-related nasal bleeding and pharyngeal bleeding, and the incidence of moderate and life-threatening complications.
The first-attempt success rate was 99.2% in group 1 compared with 56.7% in group 2 (P < 0.001). Thus, the first-attempt failure rate was 0.8% in group 1 compared with 43.3% in group 2 (P < 0.001, absolute risk reduction of first-attempt failure rate = 42.5%, 95% confidence interval [CI] = 36.0%-49.9%; numbers needed to treat = 2, 95% CI = 2-3; relative risk reduction of first-attempt failure rate = 98.1%, 95% CI = 92.3%-99.5%). The median time required to insert the NGT was significantly shorter in group 1 (55 vs 60 seconds); P < 0.001, 95% CI for the difference in means = 3.2 to 6.8 seconds. The incidences of kinking/coiling, bleeding, and moderate injuries were significantly lower in group 1.
Esophageal guidewire-assisted insertion with manual forward laryngeal displacement technique most frequently resulted in correct positioning of the NGT in anesthetized and tracheally intubated patients after the first attempt. This technique is also associated with a lower incidence of procedure-related injuries and is less time-consuming than conventional insertion techniques.
鼻胃管（NGT）插入术几乎是常规用于接受腹部手术的患者，以在术中及术后对胃进行减压，并允许术后进行管饲。NGT 由非增强型聚合物塑料制成，在插入过程中容易发生扭结和缠绕。这在盲插或使用各种描述的技术辅助插入时经常会造成困难。我们假设食管引导线辅助 NGT 插入并手动向前移动喉头可以显著提高首次尝试的成功率，而不是在麻醉和气管插管患者中使用头屈和侧颈压技术。
480 名接受全身麻醉和神经肌肉松弛的拟行腹部手术的成年患者被随机分配到食管引导线加手动向前移动喉头的实验组（1 组）或头屈和侧颈压对照组（2 组）进行 NGT 插入。评估首次和第二次尝试（以及总尝试）的成功率（和失败率），以及 NGT 扭结和缠绕、与操作相关的鼻出血和咽出血、中度和危及生命并发症的发生率。
1 组首次尝试成功率为 99.2%，而 2 组为 56.7%（P<0.001）。因此，1 组首次尝试失败率为 0.8%，而 2 组为 43.3%（P<0.001，首次尝试失败率绝对降低 42.5%，95%置信区间[CI]为 36.0%-49.9%；需要治疗的人数=2，95%CI=2-3；首次尝试失败率相对降低 98.1%，95%CI=92.3%-99.5%）。1 组插入 NGT 所需的中位数时间明显短于 2 组（55 秒对 60 秒）；P<0.001，平均值差值的 95%CI 为 3.2 至 6.8 秒。1 组扭结/缠绕、出血和中度损伤的发生率明显较低。
食管引导线辅助插入并手动向前移动喉头技术最常导致麻醉和气管插管患者在首次尝试后正确定位 NGT。该技术还与较低的操作相关损伤发生率有关，并且比常规插入技术耗时更短。
