SUZYTM forceps facilitate nasogastric tube insertion under McGRATHTM MAC videolaryngoscopic guidance

Abstract

Background: Nasogastric tubes can be easily inserted in patients under general anesthesia. However, for difficult cases, insertion techniques that can be used in routine clinical practice are limited. SUZY forceps are designed for the removal of pharyngolaryngeal foreign bodies under guidance of a McGrath videolaryngoscope. We hypothesized that using SUZY forceps under McGrath videolaryngoscopic guidance may facilitate nasogastric tube insertion and tested this in a randomized controlled trial. Methods: Adult patients who underwent gastrointestinal or hepato-pancreato-biliary surgery were randomly allocated to 2 groups; the SUZY group and the Magill group. Patients, nurses, and all clinical staff except for the attending anesthesiologist were blinded to group assignment throughout the study. After anesthesia induction, insertion of the nasogastric tube was performed by skilled anesthesiologists with either SUZY or Magill forceps according to group allocation under McGrath videolaryngoscopic guidance. The primary endpoint was insertion time which was defined as the time required to advance the nasogastric tube by 55 cm from the nostril. Secondary endpoints were the success rates of the nasogastric tube insertion, which were defined as a 55-cm advancement from the nostril at the 1st, 2nd, and 3rd attempt, proper insertion rate, the severity of pharyngolaryngeal complications, and hemodynamic parameters during nasogastric tube insertion. Results: Sixty patients were randomized and none of these patients were excluded from the final analysis. The median [interquartile range] insertion time was 25 [18–33] seconds in the SUZY group, and 33 [21–54] seconds in the Magill group ( P = .02). Success rates were not different between the groups (97% and 80% in the SUZY and Magill group at 1st attempt, respectively, P = .10). Both, the severity score of the mucosal injury and the severity of sore throat were higher in the Magill than in the SUZY group, whereas the degree of hoarseness did not differ between the 2 groups. Hemodynamic parameters were not significantly different between the groups. Conclusion: Using SUZY forceps under McGrath videolaryngoscopic guidance reduced the time required to insert a nasogastric tube and the severity of pharyngolaryngeal complications, when compared to using Magill forceps.

Laryngopharyngeal Mucosal Injury Due to Nasogastric Tube Insertion during Cardiopulmonary Resuscitation: A Retrospective Cohort Study

“…Contrastingly, the most severe mucosal injuries occurred in the posterior wall of the pharynx (RPW), compared to other regions in both the Smooth and Dif groups in the present study. Previous studies included patients undergoing general anesthesia in an operating room [ 11 , 12 ]. In contrast, the present study included patients with CPOA who were undergoing continuous CPR; thus, their necks may have been hyperextended, and passive neck movements during CPR might be involved in RPW mucosal injury [ 19 ].…”

“…Several methods have been proposed for the insertion of NGTs in patients who are intubated [ 16 , 20 ]. It has been reported that VLS-assisted NGT insertion is effective [ 12 , 18 , 21 ]. On the other hand, Nasr Isfahani and Nasri Nasrabadi [ 18 ] have recently reported that NGT insertion using two digital methods is less time-consuming and has a higher success rate, compared with VLS-assisted insertion in intubated patients at the ED.…”

“…In those patients with bleeding diathesis, minor trauma to the laryngopharynx resulting from blind NGT insertion can cause severe bleeding, which may be difficult to arrest ( Figure 1 b). In the previous study, there were some reports that blind NGT insertion in intubated patients injured hypopharynx, trachea and esophageal mucosa [ 11 , 12 ]. However, the incidence of laryngopharyngeal mucosal injury due to blind NGT insertion during CPR is poorly understood.…”

Blind nasogastric tube insertion performed within one minute or for a maximum of three attempts minimize laryngopharyngeal injury during resuscitation

“…In awake patients, the procedure is easy, as patients can cooperate by swallowing. On the contrary, in intubated patients, NG tube insertion can be di cult [20] . Ozer and Benumof [21] have reported that rst-attempt failure rates for blind insertion of an NG tube in an intubated patient can be as high as 50%.…”

“…Contrastingly, in the present study, in both the Blind and Dif groups, the most severe mucosal injuries occurred in the posterior wall of the pharynx (oropharynx) compared to other regions. Previous studies had included patients undergoing general anaesthesia in an operating room [20,21] . In contrast, the present study included patients with CPOA who were undergoing continuous CPR.…”