Ketamine improves nasogastric tube insertion

Objectives: Nasogastric (NG) intubation is one of the most common procedures performed in the emergency department (ED) and other hospital settings. The aim of this study was to compare the level of pain during NG tube insertion in groups receiving local ketamine plus water-soluble lubricating gel and water-soluble lubricating gel alone (the latter is the common practice in our hospital). It was hypothesised that ketamine has local anaesthetic effects in reducing the pain of NG tube insertion in the ED. Methods: This prospective double-blind randomised clinical trial was performed on alert haemodynamically stable subjects aged >18 years who required NG tube placement for diagnostic or therapeutic purposes in the ED of a teaching hospital during January and June 2008. The subjects were divided into two groups using randomised allocation software. The ketamine group received intranasal ketamine, while an equivalent volume of sterile water was instilled into the nasal cavity in the control group. The same amount of lubricating gel was used in both groups. The pain of NG tube placement was measured using a standard 100 mm visual analogue scale (VAS). The physician was asked to evaluate the difficulty of the procedure using a 5-point Likert scale. Results: Seventy-two subjects were enrolled in the study (36 subjects in each group). There was a significant difference between the pain score of the ketamine and control groups (19.03±3.56 vs 33.33±5.31), while the difficulty score was not statistically different between the two groups (2.39±1.25 vs 2.78±1.56). Conclusion: Intranasal ketamine is an effective agent in reducing pain during NG tube insertion among patients without serious underlying illness

The glidescope facilitates nasogastric tube insertion: A randomized clinical trial

Background: The GlideScope (Saturn Biomedical Systems, B.C., Canada) is a reusable videolaryngoscope and is considered an effective device for tracheal intubation. We designed this study to evaluate the application of this device in nasogastric tube (NGT) insertion. Methods: This randomized clinical trial was performed at a teaching hospital on 80 adult patients who required intraoperative placement of an NGT. The patients were divided into 2 groups (the control and the GlideScope group) using computerized, random allocation software. In the control group, the NGT was inserted blindly as commonly performed in operating rooms; however, in the GlideScope group, the tube was inserted with the assistance of a GlideScope. The number of attempts for NGT insertion and the time required for inserting the NGT properly along with the occurrence of possible complications were recorded. Results: The mean intubation time in the GlideScope group was 27.7 ± 20.7 s shorter than that in the control group. NGT insertion in the first attempt was successful in approximately 85 of the patients in the GlideScope group; in the control group, however, the tubes were inserted successfully after the first attempt in 57.5 of the patients. Complications were reported in 14 patients (35) of the control group and 8 patients (20) of the GlideScope group. Conclusion: GlideScope facilitates NGT insertion and reduces the duration of the procedure. Copyright © 2009 International Anesthesia Research Society