Laryngospasm during extubation. Can nasogastric tube be the culprit?

Abstract

Nasogastric tube insertion is a common clinical procedure carried out both by doctors and other paramedical personnel. Misplacement of the nasogastric tube into the tracheobronchial tree is not uncommon. It can easily be detected in awake patients with intact cough reflex. Insertion of the nasogastric tube under general endotracheal anaesthesia can be difficult and when the misplacement is not promptly detected can result in unusual and disastrous complications. Laryngospasm is not uncommon in anaesthetic practice; however, reports of recurrent laryngospasm are very sparse. We report a case of misplaced nasogastric tube causing recurrent laryngospasm.

Intraoperative Gastric Tube Intubation: A Summary of Case Studies and Review of the Literature

“…However, these ventilatory cues resulting from the negative pressure caused by the application of suctioning are not always present or diagnostic of an endobronchial placement and can go unrecognized. The potential harm introduced by an unrecognized pulmonary malposition is described in 3 case reports by Raut et al , Kerforne et al , and Nanjegowda et al [ 9 ] [ 10 ] [ 11 ]. They all report missed bronchial malpositioned GTs even in the absence of the difficulties depicted by the prior case studies.…”

“…Despite a wealth of literature spanning 20 years calling into question its validity and practice alerts made by major associations, two systematic reviews identified it as the most widely used verification method among nurses [ 33 ] [ 34 ]. Parenthetically, four of the GT complication case reports [ 7 ] [ 11 ] [ 12 ] [ 13 ] reviewed used the auscultation technique to verify placement. Nanjegowda [ 11 ] et al and Sahu & Baliarsing [ 7 ] both reported air auscultated over the epigastric although the GT was veritably endobronchial.…”

A rare cause of desaturation in an infant after anesthesia induction

“…In the literature, pneumthorax,[ 1 ] laryngospam,[ 2 ] and lung laceration[ 3 ] have been reported because of inadvertent nasogastric tube insertion. In our knowledge, this is the first case which reported nasogastric tube malpositioning leading to desaturation in an infant after anesthesia induction.…”

Anesthesia workstation ventilator malfunction due to accidental misplacement of a nasogastric tube

“…Several complications like laryngospasm have been attributed to its misplacement under anesthesia. [ 3 ]…”

“…Capnography or colorimetric capnometry for identification of feeding tube placement in mechanically ventilated adult patients is recommended. [ 5 ] Its correct intragastric position can be verified by capnography, checking the aspirate for acidic pH of 5.5 or below,[ 3 ] and by an X-ray if possible. In our case, there was no deflation of bellows with the standard amount of set gas flows.…”