Case ReportsPlacing Nasogastric Tubes and Intracranial PressureDziewas, Rainer; Sörös, Peter; Konrad, Carsten; Stögbauer, Florian; Lüdemann, PeterAuthor Information Department of Neurology, University Münster, Münster, Germany Address correspondence and reprint requests to Dr. Rainer Dziewas, Department of Neurology, University Hospital of Münster, Albert-Schweitzer-Strasse 33, 48129 Münster, Germany. Accepted for publication on July 17, 2002. Journal of Neurosurgical Anesthesiology: January 2003 - Volume 15 - Issue 1 - p 55-56 Buy Abstract Recently, a new method for placing nasogastric tubes (NGT) in dysphagic patients was proposed, which uses the swallowing reflex and was therefore called `reflex placement.` The authors describe the use of this method in a patient with a large left sided striatocapsular hemorrhage, in whom decompressive craniotomy had been performed previously. Whereas the conventional approach of placing NGT led to a massive increase of intracranial pressure (ICP) and to a decline in cerebral perfusion pressure (CPP), the new method allowed a swift placement with only minor changes of ICP and CPP. The strict avoidance of intermittent peaks of ICP constitutes a basic principle of care in patients with space occupying brain lesions. We therefore suggest that, despite the admittedly larger effort, the reflex placement of NGTs should be used in such circumstances. © 2003 Lippincott Williams & Wilkins, Inc.