Nasogastric Tube Placement on Intubated Patient: Two-Finger Method vs Reverse Sellick's Maneuver
Condition: Adult Patient Undergoing Elective Surgery With General Anesthesia and Needs Nasogastric Tube Placement
Study type: Interventional

Summary: 
      The study aimed to compare the efficacy between nasogastric tube placement using Two-Finger
      Method and Reverse Sellick's Maneuver
    

Detailed description: 
      Approval from Ethical Committee of Faculty of Medicine Universitas Indonesia was acquired
      prior conducting the study. Subjects were given informed consent before enrolling the study
      and randomized into two groups (Two-Finger method group and Reverse Sellick's maneuver
      group). Intravenous (IV) cannula with isotonic fluid, non-invasive blood pressure monitor,
      and pulse-oxymetry were set on the subjects in the operation room. Vital signs were recorded.
      Midazolam 1-2 mg and Fentanyl 2 µg/kg body weight (BW) were given as premedication. Induction
      was performed using propofol 2-3 µg/kg BW. Rocuronium 0.5mg/kg BW was also given after
      induction. Two minimum alveolar concentration (MAC) of sevoflurane and 6 liter per minute of
      oxygen were also given using face mask for 3 minutes until the drugs took effect. Patient
      were then intubated. Evaluation of airway was performed to exclude the subjects who
      experienced airway trauma. Estimating the length of nasogastric tube was performed by
      stretching the nasogastric tube from xyphoid process through nose to the back of the ear. The
      measured number in cm then added with 15 cm and marked with tape. Nasogastric tube and the
      selected nostril then covered in gel sufficiently. The Two-Finger method group was placed
      with nasogastric tube using two-finger method, before the procedure, the endotracheal tube
      cuff was deflated first. And then the nasogastric tube was inserted into the selected nostril
      perpendicularly using dominant hand. The non-dominant hand (index and middle finger) was
      inserted to the base of oropharynx until the nasogastric tube was felt , and the the
      nasogastric tube was fixated in the middle position and the base of pharynx, as nearest as
      possible from esophagus, while the dominant hand pushed the nasogastric tube until it reached
      the mark. The reverse Sellick's maneuver group's endotracheal tube was also deflated before
      the procedure. The nasogastric tube was inserted into the selected nostril perpendicularly
      using dominant hand and pushed gently until it reached the first resistance in nasopharynx.
      Reverse Sellick's maneuver was performed using non-dominant hand, done by grabbing thyroid
      cartilage upward and elevated the larynx anteriorly, while the dominant hand kept pushing the
      nasogastric tube gently until it reached the mark. Evaluation whether or not the nasogastric
      tube was properly placed was using the auscultation method in the epigastric region and
      inserting air through catheter tip. Time and complications occurred during procedure were
      recorded. And the nasogastric tube was fixated if it was successfully inserted.
    

Intervention name(s): two-finger method, reverse sellick's method
Intervention type(s): Procedure
Intervention description(s): Subjects received nasogastric tube placement by two-finger method; Subjects received nasogastric tube placement by reverse sellick's method
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Supportive Care