Nasogastric Tube Insertion in Anaesthetised, Intubated Paediatric Patients: A Comparison between Conventional Blind Method and ‘Throat Pack In-situ’ Technique
Dr. Mohanchandra Mandal,
57/4, B.T. Road, Kolkata-700002, West Bengal, India.
Introduction: Nasogastric Tube (NGT) insertion may become difficult in anaesthetised and intubated children similar to adults. In paediatrics, often anaesthesiologists are compelled to use uncuffed Endotracheal Tubes (ETT) owing to resource problem. Conventionally, NGT is inserted prior to throat pack application with the fear of difficulty later on.
Aim: To compare the â€˜throat pack in-situâ€™ method with the conventional blind insertion of NGT with respect to success rates, procedure times and adverse events.
Materials and Methods: A total of 140 anaesthetised and intubated children aged 3-12 years were evaluated for insertion of NGT either before (â€˜conventional blind techniqueâ€™, group A, n=70,) or after (â€˜throat pack in-situâ€™ method, group B, n=70) pharyngeal pack application. Success rate was the primary outcome. Studentâ€™s t-test was used for analysing numerical/ continuous data such as NGT placement time, throat pack application time and duration of fresh gas flow leak, etc. Pearson Chi-square test was utilised for categorical data such as number (proportion) of successful placement of NGT, gender distribution, ASA-PS class of patients, etc.
Results: Both the groups achieved a high (>90%), comparable success rate but group B had a favourable profile regarding adverse event. Duration of fresh gas flow leak was lesser in group B owing to early pack application before NGT insertion. (p<0.001).
Conclusion: Considering the comparable success rate and lesser adverse events, the â€˜throat pack in-situâ€™ technique appears better alternative to the conventional blind method in paediatric population where the use of uncuffed ETT with throat pack application is still common. Moreover, the duration of fresh gas leak was found to be considerably less with the use of throat-pack in-situ technique.