ABSTRACT
Abstract Background Nasogastric tube insertion may be difficult in anesthetized and intubated patients with head in the neutral position. Several techniques are available for the successful insertion of nasogastric tube. The primary aim of this study was to investigate the difference in the first attempt success rate of different techniques for insertion of nasogastric tube. Secondary aim was to investigate the difference of the duration of insertion using the selected technique, complications during insertion such as kinking and mucosal bleeding. Material and methods 200 adult patients, who received general anesthesia for elective abdominal surgeries that required nasogastric tube insertion, were randomized into four groups: Conventional group (Group C), head in the lateral position group (Group L), endotracheal tube assisted group (Group ET) and McGrath video laryngoscope group (Group MG). Success rates, duration of insertion and complications were noted. Results Success rates of nasogastric tube insertion in first attempt and overall were lower in Group C than Group ET and Group MG. Mean duration and total time for successful insertion of NG tube in first attempt were significantly longer in Group ET. Kinking was higher in Group C. Mucosal bleeding was statistically lower in Group MG. Conclusion Use of video laryngoscope and endotracheal tube assistance during NG tube insertion compared with conventional technique increase the success rate and reduce the kinking in anesthetized and intubated adult patients. Use of video laryngoscope during nasogastric tube insertion compared to other techniques reduces the mucosal bleeding in anesthetized and intubated adult patients.
Resumo Justificativa A inserção de sonda nasogástrica (NG) pode ser difícil em pacientes anestesiados e intubados com a cabeça em posição neutra. Há várias técnicas para a inserção bem-sucedida de sonda NG. O objetivo primário deste estudo foi investigar a diferença da taxa de sucesso na primeira tentativa de diferentes técnicas para inserção de sonda NG. O objetivo secundário foi investigar a diferença do tempo de inserção com o uso da técnica selecionada e as complicações durante a inserção (dobradura da sonda e sangramento da mucosa). Material e métodos 200 pacientes adultos que receberam anestesia geral para cirurgias abdominais eletivas que exigiam inserção de sonda NG foram randomicamente distribuídos em quatro grupos: grupo convencional (Grupo C), grupo com a cabeça posicionada lateralmente (Grupo L), grupo com assistência de tubo traqueal (Grupo TE) e grupo com videolaringoscópio McGrath (grupo MG). As taxas de sucesso, os tempos de inserção e as complicações foram registrados. Resultados As taxas de sucesso de inserção da sonda NG na primeira tentativa e em geral foram menores no Grupo C do que nos grupos TE e MG. As durações e os tempos totais de inserção bem-sucedida da sonda NG na primeira tentativa foram significativamente maiores no Grupo TE. Dobradura foi maior no Grupo C. Sangramento da mucosa foi estatisticamente menor no Grupo MG. Conclusão O uso de videolaringoscópio e de TE durante a inserção de sonda NG comparado com o uso da técnica convencional aumentou a taxa de sucesso e reduziu a dobradura da sonda em pacientes adultos anestesiados e intubados. O uso de videolaringoscópio durante a inserção de sonda NG em comparação com outras técnicas reduz o sangramento da mucosa em pacientes adultos anestesiados e intubados.
Subject(s)
Humans , Male , Female , Intubation, Gastrointestinal/methods , Anesthesia , Intubation, Gastrointestinal/adverse effects , Intubation, Intratracheal , Laryngoscopy , Middle AgedABSTRACT
Objective To investigate the clinical significance of measuring resting energy expenditure (REE) for guiding an accurate nutritional support in elderly bedridden patients with nasal feeding.Methods The REE of 32 elderly bedridden patients with nasal feeding was assessed by using the Cosmed K4b2 portable telemetric gas analysis system.The waist-hip ratio, serum levels of albumin, transferrin, prealbumin and retinol-binding protein were determined to assess comprehensive nutrition status.The energy intakes were calculated, and the correlation of REE and the difference between the energy intakes and consumption with nutritional index were analyzed.Results The resting energy expendture was lower in the patients with waist-hip ratio≥0.95 than in patients with waist-hip ratio ＜0.95 (t=3.622, P＜0.01).The waist-hip ratio was reduced and serum albumin and transferrin levels were decreased along with the increase of REE in elderly patients (r=-0.55,-0.36 and-0.593, respectively, P=0.001, 0.043, ＜0.001).The difference between the energy intake and expenditure was higher in patients with waist-hip ratio≥0.95 than those with waist-hip ratio＜0.95 (t =5.643, P＜ 0.001).Serum albumin, prealbumin, transferrin and retinol-binding protein levels were increased along with the increase of the difference between the energy intake and expenditure, which showed the positive correlations (r=0.525, 0.409, 0.624, 0.414, respectively,P=0.002, 0.02, ＜0.001, 0.019).Conclusions Precise determination of REE and energy intake guided by REE are the important guarantees for the reasonable nutrition support in the elderly.
ABSTRACT
Objective To evaluate percutaneous endoscopic gastrostomy (PEC) in long-term coma patients at different phases who received trans-nasal feeding in Department of Neurosurgery. Methods A total of 51 patients who received trans-nasal feeding because of long-term coma were randomly divided into 2 groups to undergo PEG at 25-39 days after coma (n =24) or at 40-60 days (n = 27) , respectively. The rates of upper gastrointestinal bleeding, average episodes of bleeding, average hemostatic time, the rates of aspiration and aspiration pneumonia were compared between the 2 groups. Results The rates of upper gastrointestinal bleeding, aspiration and aspiration pneumonia in post-PEG patients were significantly lower than those in pre-PEG patients (P < 0.05). Before the procedure of PEG, the rates of upper gastrointestinal hemorrhage,average episodes of bleeding, rates of aspiration and aspiration pneumonia in 25-39-day group were significantly lower than those in 40-60-day group (P < 0.05). There was no significant difference between 2 groups, in regarding of either hemostatic time, or rates of upper gastrointestinal bleeding, aspiration and aspiration pneumonia after PEG (P > 0. 05). Conclusion PEG may decrease the rates of upper gastrointestinal bleeding, aspiration and aspiration pneumonia in neurosurgical patients receiving trans-nasal feeding because of long-term coma. PEG is preferably performed on 25-39 days of onset to 40-60 days. If there is no contraindication, 25-39 days after coma is likely to be the optimal time for PEG.