title: Comparison of four techniques of nasogastric tube insertion in anaesthetised, intubated patients: A randomized controlled trial.
abstract: OBJECTIVE
  Insertion of nasogastric tubes (NGTs) in anaesthetised, intubated patients with a conventional method is sometimes difficult. Different techniques of NGT insertion have been tried with varying degree of success. The aim of this prospective, randomised, open-label study was to evaluate three modified techniques of NGT insertion comparing with the conventional method in respect of success rate, time taken for insertion and the adverse events.
  
  
  METHODS
  In the operation theatre of general surgery, the patients were randomly allocated into four groups: Group C (control group, n = 54), Group W (ureteral guide wire group, n = 54), Group F (neck flexion with lateral pressure, n = 54) and Group R (reverse Sellick's manoeuvre, n = 54). The number of attempts for successful NGT insertion, time taken for insertion and adverse events were noted.
  
  
  RESULTS
  All the three modified techniques were found more successful than the conventional method on the first attempt. The least time taken for insertion was noted in the reverse Sellick's method. However, on intergroup analysis, neck flexion and reverse Sellick's methods were comparable but significantly faster than the other two methods with respect to time taken for insertion.
  
  
  CONCLUSIONS
  Reverse Sellick's manoeuver, neck flexion with lateral neck pressure and guide wire-assisted techniques are all better alternatives to the conventional method for successful, quick and reliable NGT insertion with permissible adverse events in anaesthetised, intubated adult patients. Further studies after eliminating major limitations of the present study are warranted to establish the superiority of any one of these modified techniques.
authors.affiliation: Department of Anaesthesiology, North Bengal Medical College, Sushrutanagar, Darjeeling, West Bengal, India.
authors.forename: Mohan Chandra
authors.initials: MC
authors.lastname: Mandal
authors.affiliation: Department of Anaesthesiology, Medical College and Hospital, Kolkata, West Bengal, India.
authors.forename: Sujata
authors.initials: S
authors.lastname: Dolai
authors.affiliation: Department of Anaesthesiology, North Bengal Medical College, Sushrutanagar, Darjeeling, West Bengal, India.
authors.forename: Santanu
authors.initials: S
authors.lastname: Ghosh
authors.affiliation: Department of Obstetrics and Gynaecology, Medical College and Hospital, Kolkata, West Bengal, India.
authors.forename: Pallab Kumar
authors.initials: PK
authors.lastname: Mistri
authors.affiliation: Department of Orthopaedics Surgery, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Roy
authors.affiliation: Department of Anaesthesiology, North Bengal Medical College, Sushrutanagar, Darjeeling, West Bengal, India.
authors.forename: Sekhar Ranjan
authors.initials: SR
authors.lastname: Basu
authors.affiliation: Department of Anaesthesiology, North Bengal Medical College, Sushrutanagar, Darjeeling, West Bengal, India.
authors.forename: Sabyasachi
authors.initials: S
authors.lastname: Das
keywords: Adverse effects; enteral nutrition; instrumentation; intubations; nasogastric tube