Facilitated insertion of a nasogastric tube in tracheal intubated patients using the GlideScope
Editor—The insertion of a nasogastric tube in anaesthetized and intubated patients is sometimes difficult. It has been suggested that release of the endotracheal cuff would ease insertion of a nasogastric tube, by decreasing the compression of the oesophagus posteriorly through the membranous portion of the trachea. Various techniques of insertion have been described emphasizing the fact that as yet there is no simple and safe method.The GlideScope® video Laryngoscope (GVL; Saturn Biomedical Systems Inc., Burnaby, BC, Canada) is a new intubating device, designed to provide a view of the glottis with alignment of the oral, pharyngeal and tracheal axes. Several studies have suggested that the GlideScope® may provide glottic views equal to conventional direct laryngoscopy1 and has potential advantage for difficult intubation.2 3 We would like to describe an alternative method for nasogastric tube insertion using the GlideScope®.
We have performed five consecutive nasogastric tube insertions in intubated patients under general anaesthesia using the GlideScope®. The blade of the GlideScope® was inserted first into the patient's mouth to get the views of the pharyngeal and laryngeal area then the nasogastric tube was inserted via the nostril with lubrication until it reached the pharyngeal area. After that, the cuff of the tracheal tube was released and the nasogastric tube was advanced gently with the patient's chin lifted. All the nasogastric tubes could be inserted smoothly in these patients without complications such as bleeding or mucosa injury, and visualized on the monitor of the GlideScope® system. The manoeuvres we present may facilitate improved nasogastric tube placement with the GlideScope®.
Hualien, Taiwan
*E-mail: hamalai{at}yahoo.com.tw
References
1 Sun DA, Warriner CB, Parsons DG, et al. The GlideScope® Video Laryngoscope: randomized clinical trial in 200 patients. Br J Anaesth 2005; 94:381–4
2 Cooper RM, Pacey JA, Bishop MJ, McCluskey SA. Early clinical experience with a new videolaryngoscope (GlideScope) in 728 patients. Can J Anaesth 2005; 52:191–8[Web of Science][Medline]
3 Lai HY, Chen IH, Chen A, et al. The use of the GlideScope® for the tracheal intubation in patients with ankylosing spondylitis. Br J Anaesth 2006; 97:419–22
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