Conventional Blind Method Versus SORT
Manoeuvre of Nasogastric Tube Insertion in Anaesthetised Patients: A Randomised Clinical Study
UC19-UC23
Correspondence
Dr. Mohanchandra Mandal,
57/4, B.T. Road, Kolkata-02, West Bengal, India.
E-mail: drmcmandal@gmail.com
Introduction: Nasogastric Tube (NGT) placement is frequently performed in the preoperative period and critical care scenario. The SORT manoeuvre, a comparatively new method of NGT placement, is comprised of four components such as Sniffing position, Orientation of NGT, Rotation of patient’s head to the contralateral side of the nostril being used, and Twisting movements of hand. Any obstruction during introduction of NGT is managed with withdrawal of NGT a bit, and proceeding again, to find the path of least resistance, thereby reducing injury.
Aim: To determine the efficacy of SORT manoeuvre in comparison with the conventional blind method of NGT insertion in anaesthetised intubated adult patients.
Materials and Methods: The interventional, single-blinded, parallel group, randomised study was conducted in Nil Ratan Sircar Medical College and Hospital, a Government Medical College, Kolkata, West Bengal, India. A total of 202 adult patients, undergoing abdominal surgeries under general anaesthesia, and requiring intraoperative NGT placement were recruited for this study. The study spanned between February 2019 to April 2020. The patients were randomly allocated into two groups to receive NGT placement using either conventional blind technique (group B, n=101) or SORT manoeuvre (group S, n=101). The proportion of patients in each group with successful NGT placement in a single attempt was recorded. The procedure time, haemodynamic parameters and the incidence of adverse events were also noted. Chi-square test, Fisher’s-exact test, Mann-Whitney test, and t-test were applied as appropriate according to the nature of data.
Results: Successful NGT insertion in a single attempt was possible in 95 patients (94%) using SORT maneuver in comparison with 78 patients (77.2%) using conventional blind method (p-value=0.0006). The procedure time was longer using SORT method compared with that using blind method (25 vs 22 seconds, respectively; p-value=0.024). The incidence of all types of adverse events were found to be considerably lower in patients receiving NGT placement using SORT manoeuvre. In both the groups, coiling was found to be the most common adverse event and that was also considerably low with the SORT method compared with blind method (21.8% vs 43.6%, respectively; p-value=0.001).
Conclusion: The SORT manoeuvre appears to be a better alternative to conventional technique for NGT insertion in anaesthetised intubated adult patients, in terms of higher success rate and lower adverse events.