Comparing insertion characteristics on nasogastric tube placement by using GlideScopeTM visualization vs. MacIntosh laryngoscope assistance in anaesthetized and intubated patients / Comparação das características de inserção de sonda nasogástrica, usando visibilização pelo laringoscópio GlideScope® vs. guiada pelo laringoscópio MacIntosh em pacientes anestesiados e intubados

Abstract Background and objective: This was a prospective, randomized clinical study to compare the success rate of nasogastric tube insertion by using GlideScopeTM visualization versus direct MacIntosh laryngoscope assistance in anesthetized and intubated patients. Methods: Ninety-six ASA I or II patients, aged 18-70 years were recruited and randomized into two groups using either technique. The time taken from insertion of the nasogastric tube from the nostril until the calculated length of tube had been inserted was recorded. The success rate of nasogastric tube insertion was evaluated in terms of successful insertion in the first attempt. Complications associated with the insertion techniques were recorded. Results: The results showed success rates of 74.5% in the GlideScopeTM Group as compared to 58.3% in the MacIntosh Group (p = 0.10). For the failed attempts, the nasogastric tube was successfully inserted in all cases using rescue techniques. The duration taken in the first attempt for both techniques was not statistically significant; Group A was 17.2 ± 9.3 s as compared to Group B, with a duration of 18.9 ± 13.0 s (p = 0.57). A total of 33 patients developed complications during insertion of the nasogastric tube, 39.4% in Group A and 60.6% in Group B (p = 0.15). The most common complications, which occurred, were coiling, followed by bleeding and kinking. Conclusion: This study showed that using the GlideScopeTM to facilitate nasogastric tube insertion was comparable to the use of the MacIntosh laryngoscope in terms of successful rate of insertion and complications.

Resumo Justificativa e objetivo: Este foi um estudo clínico prospectivo e randômico para comparar a taxa de sucesso da inserção de sonda nasogástrica (NG) com as técnicas de visibilização guiada pelo laringoscópio GlideScope® versus guiada pelo laringoscópio MacIntosh em pacientes anestesiados e intubados. Métodos: Foram recrutados 96, ASA I ou II, entre 18-70 anos, e divididos randomicamente em dois grupos, com uma ou outra técnica. Foi calculado o tempo transcorrido desde a inserção da sonda NG, da narina até a inserção do comprimento calculado da sonda. A taxa de sucesso de inserção da sonda NG foi avaliada quanto à inserção bem-sucedida na primeira tentativa. As complicações associadas às técnicas de inserção foram registradas. Resultados: Os resultados mostraram taxas de sucesso de 74,5% para o grupo GlideScope® em comparação com 58,3% para o grupo MacIntosh (p = 0,10). Para as tentativas que falharam, a sonda NG foi inserida com sucesso em todos os casos, com as técnicas de resgate. A duração da primeira tentativa para ambas as técnicas não foi estatisticamente significativa: 17,2 ± 9,3 segundos no Grupo A e 18,9 ± 13,0 segundos no Grupo B (p = 0,57). No total, 33 pacientes desenvolveram complicações durante a inserção da sonda NG: 39,4% no Grupo A e 60,6% no Grupo B (p = 0,15). As complicações mais comuns ocorridas foram enrolamento, seguido de sangramento e dobradura. Conclusão: Este estudo mostrou que o uso do GlideScope® para facilitar a inserção de sonda nasogástrica foi comparável ao uso do laringoscópio MacIntosh quanto à taxa de sucesso de inserção e às complicações.

A Randomized Controlled Trial of Comparison on Time and Rate of Cecal and Termianl Ileal Intubation according to Adult-Colonoscope Length: Intermediate versus Long

For a complete colonoscopic examination, a high intubation rate and a short intubation time have been demanded to colonoscopists, if possible. The aim of the present study was to compare these examination parameters, intubation time and rate, according to the length of colonoscope. A total of 507 healthy Korean subjects were randomly assigned into two groups: intermediate length adult-colonoscope (n=254) and long length adult-colonoscope (n=253). There were significant differences in cecal intubation time and in terminal ileal intubation rate according to the length of the colonoscope. Time-to-cecal intubation was shorter for the intermediate-scope group than for the long-scope group (234.2 +/- 115.0 sec vs 280.7 +/- 135.0 sec, P < 0.001). However, the success rate of terminal ileal intubation was higher in the long-scope group than in the intermediate-scope group (95.3% vs 84.3%, P < 0.001). There were no significant differences in other colonoscopic parameters between the two groups. The intermediate length adult-colonoscope decreased the time to reach the cecum, whereas the long-scope showed a success rate of terminal ileal intubation. These findings suggest that it is reasonable to prepare and use these two types of colonoscope appropriate to the needs of the patient and examination, instead of employing only one type of colonoscope.

Medidas antropométricas na introdução da sonda nasogástrica para nutrição enteral empregando a esofagogastroduodenoscopia / Anthropometric measures for the introduction of the nasogastric tube for enteral nutrition employing the esophagogastroduodenoscopy

RACIONAL: O correto posicionamento da sonda nasogástrica para nutrição enteral tem sido alvo de várias investigações, demonstrando as controvérsias e a complexidade do procedimento. OBJETIVO: Prever as medidas antropométricas para realizar a inserção de sonda para nutrição enteral até o estômago empregando a esofagogastroduodenoscopia para calcular-se o comprimento necessário até o estômago. MÉTODO: Medidas externas foram obtidas entre a ponta do nariz vs lobo da orelha vs apêndice xifóide vs umbigo e altura correlacionadas com a medida padrão obtida em pacientes submetidos à esofagogastroduodenoscopia diagnóstica. RESULTADOS: Encontrou-se correlação estatisticamente significativa entre a transição esofagogástrica identificada durante a endoscopia, acrescida da distância da rima labial à arcada dentária superior, com a distância compreendida entre os pontos anatômicos lóbulo da orelha e apêndice xifóide (r=0.75). CONCLUSÃO: A distância entre o lóbulo da orelha ao apêndice xifóide (0.75) e a distância entre o lóbulo da orelha ao apêndice xifóide até o ponto médio da cicatriz umbilical, subtraindo a distância da ponta do nariz ao lóbulo da orelha, foram parâmetros anatômicos seguros para estimar-se a distância da transição esofagogástrica. A altura na posição em pé (r = 0,72) também pode ser utilizada como um indicador da distância necessária para inserir o tubo no estômago.

BACKGROUND:The correct placement of a nasogastric tube for enteral nutrition is subject of several investigations, demonstrating the controversy of the procedure. AIM: To establish an external measure that can correspond to the internal measurement which determines the insertion length of nasogastric feeding tube up to the stomach. METHODS: External measures were obtained between points: nose tip vs earlobe vs xiphoid appendix vs umbilicus and height correlated with the standard measures obtained from patients undergoing diagnostic esophagogastroduodenoscopy. RESULTS: It was found a significative statistical correlation between esophagogastric junction, identified during the esophagogastroduodenoscopy, with the distance measured between the anatomic points of the earlobe and xiphoid appendix (r= 0.75) and from this line with the orthostatic height (r=0.72). CONCLUSION: The distance between the earlobe to the xiphoid appendix (0.75) and the distance between the earlobe to the xiphoid appendix to the midpoint of the umbilicus, subtracting the distance from tip of nose to earlobe, were safe anatomical parameters to reach the esophagogastric junction. The height in the standing position (r= 0.72) also can be used as an indicator of the length necessary to insert the tube into the stomach. The height in the standing position (r= 0.72) also can be used as an indicator of the length necessary to insert the tube into the stomach.

Percutaneous endoscopic gastrostomy tube placement for end-stage palliation of malignant gastrointestinal obstructions

Decompression of malignant gastrointestinal obstructions is an uncommon indication for percutaneous endoscopic gastrostomy [PEG] tubes. The purpose of this study is to determine the efficacy of venting PEG tubes in relieving nausea and vomiting and assessing complications associated with tube placement. This study is a retrospective chart review of patients with PEG tubes placed to decompress malignant gastrointestinal obstructions between January 2005 and September 2010 by the gastroenterology service at our institute. Patient demographics, symptom relief, procedural complications, diet tolerability and home palliation were reviewed. Seven PEG tubes were inserted to decompress malignant gastrointestinal obstructions. The mean patient age was 62 years [range 37-82 years]. The underlying primary malignancies were small intestine [1], appendiceal [1], pancreatic [2], and colon [3] cancer. Gastric outlet obstruction was present in 3 [43%] patients while small bowel obstruction occurred in 4 [57%] patients. There was relief of nausea and vomiting in 6 [86%] patients. Procedural complications were present in 1 [14%] patient and involved superficial cellulitis followed by peristomal leakage. Patients with gastric outlet obstruction continued to have limited oral intake while patients with small bowel obstruction tolerated varying degrees of oral nutrition. Six [86%] patients were discharged home after PEG tube placement, but only 2 [33%] were able to undergo end-stage palliation at home without re-admission for hospital palliation. Venting PEG tubes significantly reduce the symptoms of nausea and vomiting in patients with metastatic gastrointestinal obstruction due to primary gastrointestinal malignancies. Complications associated with tube placement were minimal

New single use supraglottic airway device with non-inflatable cuff and gastric tube channel

To assess ventilatory characteristics and airway complications associated with the use of I-gel in patients undergoing gynaecological surgeries. Experimental study. Department of Anaesthesiology, Surgical Intensive Care Unit and Pain Management, Civil Hospital, Dow University of Health Sciences, Karachi, from July 2008 to June 2009. One hundred adult female patients aged 15 - 75 years, ASA-I and II scheduled for elective gynaecologic surgical procedures under general anaesthesia with controlled ventilation were included in this study. After insertion of device, ease of insertion, time of insertion, peak airway pressure, leak pressure were noted. After proper placement of device, gastric tube was also passed in every patient. Pharyngolaryngeal morbidities [sore throat, dysphagia, dysphonia, neck pain and coughing at 1 hour and 24 hours postoperatively] were also noted. I-gel was inserted in the first attempt in 92% patients while second attempt was required in 8% of patients. Average time of insertion was 9.68 +/- 2.69 seconds. Average leak pressure of 22.48 +/- 2.07 cm H[2]O. After removal of I-gel no blood staining was found on any device. Coughing was noted in 6% patients after removal of device and mild sore throat was noted in only one patient after 24 hours of surgery. I-gel is a simple and easy to use supraglottic airway device. Its insertion do not require laryngoscopy and airway can be maintained in very short time in adult female patients

Airway device; comparison of l-GEL supraglottic with laryngeal mask airway

Intersurgical-gel [I-gel] is a new supraglottic airway device that is widely being used to secure airway during general anaesthesia. The objective of the study is to compare the ease of insertion of Intersurgical-gel and Laryngeal mask airway [LMA]. This study was conducted in Department of anaesthesia Hameed Latif Hospital, Lahore. 100 American Society of Anesthesiologists [ASA] I-II, patients were enrolled in this study for elective surgery divided in 2 groups of 50 each. LMA and l-gel were used in groups A and B respectively for intra operative maintenance of airway. Randomization through random number table in Statistical Package for Social Sciences [SPSS] version 17 was used. There were 50 patients in both groups. There were no statistical significant difference between the patients age of two groups. There was absolutely no difference between 2 groups regarding ease of insertion because both groups had 84% easy and 16% satisfactory insertions. Insertion time of LMA and l-gel in first and second attempt were also comparable and statistically nonsignificant. Airway manipulations was required in both groups for insertion of device, in LMAgroup 30% required and 70% did not require and in i-gel group 48% required and 52% did not require. There is no statistical significant difference between both groups. Bleeding was noticed on 2% of i-gel and with LMA no bleeding occurred and 2% laryngospasm incidence noticed in both groups. we found that regarding ease of insertion there is statistically no significant difference between l-gel and LMA

A Case of Afferent Loop Syndrome Treated by Endoscopic Drainage Procedure using Nasogastric Tube / 대한소화기학회지

Afferent loop syndrome is an uncommon complication which occurs in patients with Billroth II partial gastrectomy. Clinically, the diagnosis of afferent loop syndrome may be difficult to establish and thus, depends on the finding of computed tomography, abdominal ultrasound, barium studies and hepatobiliary scan. When the diagnosis is made, most of the cases are treated by surgical operation. We present a case of 67-year-old male patient with afferent loop syndrome associated with acute pancreatitis which was treated by endoscopic drainage procedure using a nasogastric tube.

White phosphorus poisoning--explosive encounter.

Poisoning by white or yellow phosphorus is reported in various forms and also in ages varying from infants to adults, but spontaneous combustion and explosion during its management has never been described. This incidence occurred while attempting to pass a Ryle's tube. Its free end first exhibited a yellow flame and this later on led to an explosive encounter. Role of static electricity generated while handling plastic materials leading to ignition and explosion cannot be overlooked.

Administracion de nutricion a traves de sonda nasogastrica: problemas comunes e intervenciones de enfermeria / Nutrition administration through nasogastric tube: common problems and nursing intervention

La alimentación a través de sonda nasogástrica es un procedimiento con frecuencia realizado por el enfermero quien debe estar capacitado no sólo para la ejecución de la técnica de inserción de la sonda y administración de la dieta, sino también, para intervenir ante las complicaciones. Este es un estudio descriptivo cuyo objetivo fue el de identificar, averiguar, entre pacientes hospitalizados que recibían alimentación a través de la sonda nasogástrica, las complicaciones presentadas e identificar las intervenciones efectuadas frente a estas complicaciones. Los datos fueron recolectados por medio de una entrevista a 85 pacientes y a través de la consulta de sus historias clínicas. Las complicaciones más frecuentes encontradas fueron las gastrointestinales seguidas de las mecánicas (salida y obstrucción de la sonda). La mayoría de las intervenciones de enfermería estuvieron relacionadas con la disminución de la velocidad de infusión y suspensión de la dieta, inserción de otra sonda, cuidados de higiene y comodidad del paciente

Sonda nasoyeyunal larga: método endoscópico de colocación y su utilidad en el manejo nutricional de la pancreatitis aguda / Long nasojejunal feeding tube: an endoscopic method for its placement and its use in enteral nutrition for patients with acute pancreatitis

Background: Enteral nutrition can be useful for the feeding of patients with acute pancreatitis, specially in the later phases of the disease. Aim: To describe an endoscopic placement method for long nasojejunal tubes and assess its efficacy. To communicate a preliminary experience with enteral nutrition in patients with acute pancreatitis. Patients and methods: An endoscopic placement method for nasojejunal tubes is described. In 24 patients with acute pancreatitis, 28 tubes were placed using this method, after the second week of evolution. In 15 patients with brain damage, traditional nasojejunal feeding tubes were placed without endoscopy. The position of both types of tubes was determined by fluoroscopy with the aid of contrast media. Results: The endoscopic placement method was simple and the tube was placed beyond the ligament of Treitz in all patients. No traditional tube was placed in the jejunum and contrast media filled the duodenum in all cases. In patients with acute pancreatitis, enteral nutrition was well tolerated, 5 patients had a higher stool frequency and one, had an asymptomatic increase in serum amilase levels. Conclusions: Long nasojejunal tubes can be easily placed beyond the ligament of Treitz with endoscopic aid and can be used for enteral feeding in patients with acute pancreatitis

Nudo en sonda de alimentacion naso yeyunal: una complicacion no descripta? / Nudo in nasojejunal tube nutrition: the complication not described

Se comunica una complicación no descripta de la sonda nasoyeyunal, un nudo en la misma. Se analiza la frecuencia, tipos, motivos de esta complicación y sugerencias para evitarla.

Diseño de una técnica de enfermería para la instalación de la sonda nasoyeyunal / Designe of a nursing technique for nosoyeyunal catheter instalation

Se elabora un método de instalación de Sonda Nasoyeyunal, el que se caracteriza principalmente por la importancia de aspirar todo el contenido gástrico. El presente trabajo tiene como objetivo demostrar la eficacia de la Técnica. Para ello, se realizó un estudio retrospectivo de los pacientes hospitalizados en la Unidad de Cuidados Intensivos del I.S.T, en el período comprendido entre Enero de 1993 y Marzo de 1995. En todos estos pacientes se encontraba indicada la nutrición enteral como parte de su tratamiento. Se comprueba que de los 31 pacientes en que se realizó la técnica, que en adelante se describirá, hubo un cien porciento de efectividad en la instalación de dicha sonda

Técnica simples e rápida de intubaçäo para obtençäo de secreçäo jejunal / Simple and rapid technique of intubation for obtention of jejunal secretion

Este estudo foi proposto para introduzir uma técnica nova e mais rápida de intubaçäo para obtençäo de secreçäo jejunal. A utilizaçäo de um "fio guia" introduzido no lúmen da sonda propicia uma maior rigidez ao conjunto, o que facilita a progressäo manual da sonda. Foi analisado comparativamente o tempo dispendido na passagem da sonda até o intestino delgado entre a técnica convencional e a do "fio guia" em 40 lactentes. O tempo de intubaçäo foi menor com a técnica do "fio guia" (x = 15,4 min) do que a convencional (x = 91,0 min) (p < 0,05). Para simplificar o método, a determinaçäo da posiçäo do tubo foi realizada pela observaçäo da mudança de coloraçäo do líquido de drenagem da extremidade proximal da sonda e da determinaçäo do pH do aspirado intestinal

Valoración de la microperfusión esplánica en el postoperatorio inmediato de pacientes críticos / Splanchnic microperfusion evaluation in the postoperative of surgical ill patients

En la presente comunicación se analiza la relación existente entre el estado de la microperfusión esplánica y la incidencia de fallas orgánicas, sepsis y mortalidad, en el postoperatorio de pacientes quirúrgicos críticos. El flujo esplánico fue evaluado directamente a través de la medición del pH intracelular de la mucosa gástrica (pHi). Se estudiaron en forma prospectiva 125 pacientes críticos, operados por patología abdominal. El pHi se midió durante las primeras 24 horas del postoperatorio mediante un tonómetro ubicado en la cavidad gástrica. Se diferenciaron dos grupos de enfermos, Grupo I: con todas las mediciones de pHi superiores a 7.40 y Grupo II: con una o más determinaciones iguales o inferiores a 7.40. La sumatoria de puntos Apache II y el promedio de falls orgánicas fueron significativamente inferiores en el Grupo I (12.6 y 0.4 respectivamente vs. 16.1 y 1.1 respectivamente en el Grupo II) con una p<0.01. Fallecieron 39 pacientes (31.2//). El pHi fue significativamente superior en los sobrevivientes, a partir de las 6 horas del postoperatorio. Otros parámetros habitualmente utilizados para evaluar la gravedad, no mostraron diferencias significativas en ese momento de la evolución. La incidencia de fallas orgánicas y sepsis fue mayor en los fallecidos. La medición del pHi en las primeras 24 horas del postoperatorio fue útil para predecir la evolución de los pacientes

Nutrición enteral: técnica de inserción activa de la sonda de Dobbhoff a la cabecera del enfermo crítico: experiencia con 30 pacientes / Enteral nutrition I: technique of active placement of dobbhoff feeding tube in critically ill patients: report of 30 cases

En el presente artículo se describe una técnica para la inserción activa de la sonda de Dobbhoff para alimentación enteral en pacientes críticos. la técnica es sencilla y segura de realizar a la cabecera del enfermo y puede ser exitosa en la mayoría de los casos facilitando la nutrición enteral precoz en pacientes críticos. El cambio del pH de la secreción aspirada durante la inserción de la sonda de ácido a alcalino parece ser el método más exacto para localizar el tubo dentro del intestino delgado