How should the nasogastric tube (NGT) be managed during induction?

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.