Comparison of a curved forceps with a conventional straight forceps for nasogastric tube insertion under videolaryngoscopic guidance

Abstract

Background:Nasogastric tube (NGT) insertion is an easy procedure that can be routinely performed under general anesthesia. However, for difficult cases, there are limited insertion techniques available in routine clinical practice, considering the flexibility of NGTs. The SUZY curved forceps are designed for the removal of pharyngolaryngeal foreign bodies under guidance of the McGRATH MAC (McG) videolaryngoscope. Because McG enables clear visualization of the esophageal inlet, we hypothesized that the SUZY forceps can facilitate easier NGT insertion compared with the conventional Magill forceps under McG guidance and designed a randomized, crossover manikin study to test this hypothesis.Materials and Methods:Ten anesthesiologists participated in this study. Each participant was instructed to insert an NGT using either the SUZY or the Magill forceps under McG guidance. Both types of forceps were used by each participant in a computer-generated random order. The primary outcome measure was the number of “strokes” (1 stroke was defined by a specific sequence of participant actions) required to advance the NGT 30 cm from the starting point. Data are expressed as medians (interquartile ranges [ranges]).Results:The number of strokes required for NGT insertion was fewer in the SUZY group than in the Magill group {7 [7.0–12.5 (5–14)] vs 16.5 [13.5–20.3 (7–22)]; P <.05}. The time required for NGT insertion was also lesser in the SUZY group than in the Magill group {15.4 [13.7–20.0 (7.0–38.3)] seconds vs 30.3 [22.0–42.3 (12.8–47.5) seconds]; P <.05}.Conclusions:The SUZY curved forceps facilitated NGT insertion more effectively than the Magill straight forceps under McG guidance. Our results suggest that NGT insertion using the SUZY forceps under McG guidance is a secure and easy procedure.

SUZYTM forceps facilitate nasogastric tube insertion under McGRATHTM MAC videolaryngoscopic guidance

“…Because NGT insertion was performed by skilled anesthesiologists in this study, the results cannot be simply applied to anesthesia trainees or residents. However, in our previous manikin study, [ 19 ] we showed that the skill required to insert an NGT using Magill forceps would be greater than when using SUZY forceps under McGrath videolaryngoscopic guidance. Therefore, if trainees or residents were to insert the NGT using either of these forceps, the difference may be larger than that found in our present study.…”

“…Our previous manikin study [ 19 ] demonstrated that SUZY forceps could advance the NGT for a longer distance than Magill forceps during insertion of the NGT from the pharynx to the esophagus. This advantage likely reduced the insertion time.…”

“…[ 1 , 2 , 4 , 5 , 10 , 20 – 22 ] It is possible that the success rate was elevated simply due to use of the McGrath videolaryngoscope, regardless of the forceps used, although no randomized trials have been performed using only McGrath videolaryngoscopy as an intervention for NGT insertion except for our study. [ 19 ] Because the tips of both forceps can be clearly visualized on the McGrath monitor, McGrath videolaryngoscopy would improve NGT insertion via Magill forceps as well as via SUZY forceps. Indeed, it has been reported that insertion of a transesophageal echocardiographic probe was facilitated simply by using McGrath videolaryngoscopic guidance.…”

“…In a Mannikin study, we reported that SUZY forceps facilitated NGT insertion more effectively than did Magill forceps under McGrath videolaryngoscopic guidance. [ 19 ] Moreover, because a recent randomized controlled trial revealed that using the modified Magill forceps with the Glidescope facilitated NGT insertion, [ 20 ] it seemed possible that using SUZY forceps with the McGrath videolaryngoscope could also facilitate NGT insertion. However, this has not yet been established in clinical practice.…”