A Comparative Study Using Four Different Techniques of Nasogastric Tube Insertion in Anaesthetised and Intubated...

Insertion of a nasogastric tube (NGT) in anaesthetised and intubated patients remains technically challenging, with conventional methods reporting more than 50% first-attempt failures. Factors such as anatomical barriers, kinking and trauma contribute to difficulties. Since laparoscopic procedures require gastric decompression, alternative methods have been introduced to improve success and safety. This study compared four insertion techniques: conventional, guidewire-assisted, slit endotracheal tube-guided and neck flexion with lateral pressure.

This prospective randomized controlled trial included 240 adults (ASA I-II) undergoing laparoscopic surgery under general anaesthesia between November 2018 and July 2020. Patients were randomly allocated into four groups (n=60 each): Group C (conventional), Group G (guidewire-assisted), Group E (slit endotracheal tube-guided) and Group N (neck flexion with lateral pressure). The primary outcome was first-attempt success. Secondary outcomes included insertion time and complications (kinking, coiling, trauma). Chi-square and ANOVA tests were applied (SPSS v22, p<0.05 significant).

Group E achieved the highest first-attempt success rate (90%), followed by G (71.7%), N (70%) and C (53.3%) (p<0.001). Mean insertion times were shortest with Group C (19.5 ± 2.1 s) and longest with Group E (34.0 ± 3.5 s). Kinking was most frequent in Group C (25%), but absent in Groups G and E. Coiling was highest in Group C (21.7%). Trauma incidence was the greatest in Group E (31.7%) and the lowest in Group C (11.7%).

Modified techniques improve first-attempt success compared to the conventional method. Although the slit endotracheal tube achieved the highest success, it was associated with greater trauma and longer insertion time. Guidewire-assisted insertion offered the most balanced profile of success, efficiency and minimal complications, thus making it a reliable alternative.