How
should the nasogastric tube (NGT) be managed during induction?
There are different thoughts regarding the
management of the NGT during the induction of general anesthesia. The NGT
should be suctioned prior to induction. There are those who, after this initial
suctioning of the NGT, would remove it. This is based on the theory that there
is a decrease in both lower and upper esophageal sphincter tone with an NGT in
situ. In addition, it is felt that the NGT will interfere with esophageal
compression from the cricoid pressure applied during a rapid sequence
induction. These concerns have not been proven. Alternatively, some recommend
leaving the NGT in place. This will allow for the continuous drainage of
gastric fluid and air thus decreasing the increase in gastric pressure
associated with induction. Still others suggest withdraw-ing the NGT to the
mid-esophageal level (approximately 30 cm from the nares) to decrease
esophageal pressure during induction and thereby decreasing the risk of
esophageal rupture.
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