Comparison of videolaryngoscopy and direct laryngoscopy for nasogastric tube placement

Abstract

© 2020 Journal of The Medical Association of Thailand. Background: Nasogastric tube (NGT) placement can be accomplished using a blind technique, but the failure rate is high, especially in anesthetized and tracheally intubated patients. Practically, mouth opening with a direct laryngoscopy is the alternative method attempted for guiding the NGT under direct visualization. However, limitations of this approach include the narrowing of the oral space and limited periglottic view, which should be resolved by using videolaryngoscope. Objective: To compare the success rate of a videolaryngoscope (C-MAC D-Blade; Karl Storz, Tuttlingen, Germany) with a direct laryngoscope for NGT insertion. Materials and Methods: Eighty-four adult patients were enrolled in the study and randomized into two groups, the videolaryngoscopy group and the direct laryngoscopy group. After induction of anesthesia and tracheal intubation, the participants in the videolaryngoscopy group and direct laryngoscopy group underwent laryngoscopy using a C-MAC D-Blade and Macintosh blade, respectively. The time from entrance of the NGT into the nostril until confirmation of the proper tip position was recorded and defined as successful insertion. The number of attempts was defined as the number of times the tube was withdrawn from the nostril and reinserted. Placement more than three times was defined as procedure failure. Bleeding was also observed. Results: The videolaryngoscopy group had a significantly higher success rate at the first attempt than the direct laryngoscopy group (78.57% versus 30.95%, respectively; p<0.001). The mean time for NGT insertion in the videolaryngoscopy group was significantly shorter than in the direct laryngoscopy group (80 versus 170 seconds, respectively, p<0.01). Direct laryngoscopy failed in five cases, however, all were successful by subsequent videolaryngoscopy. Videolaryngoscopy failed in two cases, but tube insertion was eventually successful by placement of a guide wire in the NGT. Bleeding occurred in 40.48% and 4.76% of patients in the direct laryngoscopy and videolaryngoscopy groups, respectively. The difference was statistically significant. Conclusion: Videolaryngoscopy is easier and faster for NGT placement and is associated with a lower incidence of bleeding complications and a higher success rate. Therefore, this method should be considered as an alternative option when encountering difficulty inserting the NGT using the conventional technique.