Comparison of Three Techniques of Nasogastric Tube Insertion Without Instrumentation

Study Overview
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Brief Summary
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This study compares two modified techniques(contralateral cricothyroid pressure and ipsilateral head turning technique) of nasogastric tube insertion in anesthetized and intubated patients with the conventional technique.

Detailed Description
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The insertion of nasogastric tube in anesthetized, paralysed and intubated unconscious patients may be difficult, with a reported failure rate of nearly 50% on the first attempt, with the head in neutral position there are many different maneuvers to facilitate the insertion of nasogastric tube published. Our hypothesis is that contralateral cricothyroid pressure to the selected nostril for nasogastric tube insertion will be able to avoid the difficulty. Therefore we are going to compare this technique with the conventional technique (head in neutral position) with lateral head turning group and contralateral cricothyroid pressure group We hope that the contralateral cricothyroid pressure will increase the success rate, as this will be helpful in intubated patients with neck pathology.

Official Title
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Comparison of Three Techniques of Nasogastric Tube Insertion Without Instrumentation in Anesthetised Intubated Patients: A Prospective Randomized Controlled Trial

Conditions
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General Anesthesia

Intervention / Treatment
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* Other: Conventional technique
* Other: Contralateral cricothyroid pressure
* Other: Ipsilateral head turning


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: patient who is scheduled for elective surgery under general anaesthesia requiring NGT insertion aged 20 to 70 years old with normal airway (Commack Lehane 1 or 2) and neck movements. Exclusion Criteria: Patient who has nasal stenosis, nasal septal deviation, upper airway deformity, base of skull fracture, oesophageal disorders, coagulopathy, and pregnant.

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Conventional technique<br>Nasogastric tube | Other: Conventional technique<br>* Nasogastric tube insertion with patient's head in neutral position<br>|
| Experimental: Contralateral cricothyroid pressure<br>Nasogastric tube | Other: Contralateral cricothyroid pressure<br>* Cricothyroid pressure is applied externally in the contralateral direction of selected nostril before nasogastric insertion.<br>|
| Experimental: Ipsilateral head turning<br>Nasogastric tube | Other: Ipsilateral head turning<br>* Patient's head is turned to the ipsilateral side of the selected nostril before nasogastric tube insertion.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Overall success rate | Percentage | At induction of general anesthesia | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| First attempt success rate | Percentage | At induction of general anesthesia | 
| Time taken to successful nasogastric tube placement | Procedure start time is defined as the time when the nasogastric tube is inserted through the nostril. The procedure end time is defined as the time of successful insertion and confirmed NGT placement or the time after two failed attempts. The outcome is measured in second. | At induction of general anesthesia | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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nasogastric tube, general anesthesia, head position