title: The difficult intraoperative nasogastric tube intubation: A review of the literature and a novel approach.
abstract: Nasogastric tube intubation of a patient under general anesthesia with an endotracheal tube in place can pose a challenge to the most experienced anesthesiologist. Physiologic and pathologic variations in a patient's functional anatomy can present further difficulty. While numerous techniques to the difficult nasogastric tube intubation have been described, there is no consensus for a standard approach. Therefore, selecting the most appropriate approach requires a working knowledge of the techniques available, mindful consideration of individual patient and clinical factors, and the operator's experience and preference. This article reviews the relevant literature regarding various approaches to the difficult nasogastric tube intubation with descriptions of techniques and results from comparative studies if available. Additionally, we present a novel approach using a retrograde technique for the difficult intraoperative nasogastric tube intubation.
authors.affiliation: Florida Gulf-to-Bay Anesthesiology Associates, Tampa, FL, USA.
authors.forename: Yiu-Hei
authors.initials: YH
authors.lastname: Ching
authors.affiliation: Florida Gulf-to-Bay Anesthesiology Associates, Tampa, FL, USA.
authors.forename: Stephanie M
authors.initials: SM
authors.lastname: Socias
authors.affiliation: Department of Surgery, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Ciesla
authors.affiliation: Florida Gulf-to-Bay Anesthesiology Associates, Tampa, FL, USA; Department of Surgery, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Karlnoski
authors.affiliation: Florida Gulf-to-Bay Anesthesiology Associates, Tampa, FL, USA; Department of Surgery, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
authors.forename: Enrico M
authors.initials: EM
authors.lastname: Camporesi
authors.affiliation: Florida Gulf-to-Bay Anesthesiology Associates, Tampa, FL, USA; Department of Surgery, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
authors.forename: Devanand
authors.initials: D
authors.lastname: Mangar
keywords: Anesthesiology; esophagectomy; nasogastric intubation