Secondary Logo

Journal Logo

Beware of Lung Complications When Using Guidewire-Assisted Nasogastric Tube Insertion

Moon, Ho Sik MD; Kang, Jong-Man MD, PhD; Chon, Jin Young MD, PhD

doi: 10.1213/ANE.0b013e31827696df
Letters to the Editor: Letters & Announcements
Free

Department of Anesthesiology and Pain Medicine, The Catholic University of Korea, College of Medicine, Seoul, South Korea

Department of Anesthesiology and Pain Medicine Kyung Hee University Hospital at Gangdong, Seoul, South Korea

Department of Anesthesiology and Pain Medicine, The Catholic University of Korea, College of Medicine, Seoul, South Korea anestha@catholic.ac.kr

Back to Top | Article Outline

To the Editor

We agree with Kirtania et al.1 that using a Savary-Gilliard (SG) guidewire along with gentle manual forward displacement of the larynx increases the likelihood for success of nasogastric tube (NGT) insertion in anesthetized and tracheally intubated patients.

Since 2006, we have used an SG guidewire whenever the patients require insertion of an NGT under general anesthesia.2 We have 13 operating rooms and perform approximately 800 operations every month, one third to half of which require insertion of an NGT. We have an SG guidewire in each operating room and reuse them after proper sterilization.

However, there are several differences between the technique and results of Kirtania et al. and our experience. First, we do not alter the handle of the SG guidewire. Rather than keeping it inside the sheath, we store it to maintain its intrinsic curvature.

Second and in contrast to Kirtania et al.,1 who report an absence of serious complications, during the 7 years of its use, we have seen 11 cases of lung-related complications including placing the NGT into the trachea near the carina or bronchi (5 cases), pneumothorax (3 cases), and carinal bleeding (3 cases). Two of these cases required treating a pneumothorax using chest tube drainage during anesthesia. We therefore recommend using a method such as ultrasonography3 to confirm placement of the NGT guidewire assembly as well as to detect the presence of complications such as pneumothorax.

Ho Sik Moon, MD

Department of Anesthesiology and Pain Medicine

The Catholic University of KoreaCollege of Medicine

Seoul, South Korea

Jong-Man Kang, MD, PhD

Department of Anesthesiology and Pain Medicine Kyung Hee University Hospital at Gangdong

Seoul, South Korea

Jin Young Chon, MD, PhD

Department of Anesthesiology and Pain Medicine

The Catholic University of Korea

College of Medicine

Seoul, South Korea

anestha@catholic.ac.kr

Back to Top | Article Outline

REFERENCES

1. Kirtania J, Ghose T, Garai D, Ray S. Esophageal guidewire-assisted nasogastric tube insertion in anesthetized and intubated patients: a prospective randomized controlled study. Anesth Analg. 2012;114:343–8
2. Lee HJ, Chon JY, Choi JH, Choi HJ, Moon SH. Nasogastric tube insertion using Savary-Gilliard wire guide in a comatose patient. Korean J Crit Care Med. 2006;21:135–9
3. Kim HM, So BH, Jeong WJ, Choi SM, Park KN. The effectiveness of ultrasonography in verifying the placement of a nasogastric tube in patients with low consciousness at an emergency center. Scand J Trauma Resusc Emerg Med. 2012;20:38
© 2013 International Anesthesia Research Society