Comparison of ease of nasogastric intubation with or without application of Reverse Sellick’s manoeuvre using a cold nasogastric tube in anaesthetized, intubated adult patients. A prospective, randomized, open label, parallel assignment study

Abstract

Background: Insertion of a nasogastric tube (NGT) in anaesthetized and endotracheally intubated patients can be technically difficult because of tube coiling, kinking, and impaction at the upper airway structures. Various techniques have been proposed to improve the success of NGT placement, including cooling the tube to increase its rigidity and the use of Reverse Sellick’s manoeuvre to facilitate esophageal entry.

Aim: To determine the success rate of nasogastric intubation with a cold NGT with Reverse Sellick’s manoeuvre by a doctor in training in adult human participants with endotracheal tube in-situ.

Methods: This prospective, randomized, open-label trial included 130 adult patients undergoing general anaesthesia who required NGT insertion. Participants were randomly assigned to either the cold NGT group (Group C, n=65) or the cold NGT with Reverse Sellick’s manoeuvre group (Group RS, n=65). The primary outcome was successful placement on the first attempt. Secondary outcomes included second-attempt success, overall success rate confirmed by radiography, procedure duration, and insertion-related complications.

Results: The first-attempt success rate was higher in Group RS than in Group C (70.8% vs. 58.5%), although the difference was not statistically significant (p=0.140). Group RS demonstrated significantly greater second-attempt success (84.2% vs. 55.6%; p=0.040) and overall success rates (95.4% vs. 81.5%; p=0.010). The mean insertion time was significantly shorter in Group RS (36.6±17.1 seconds) compared with Group C (47.6±21.5 seconds; p=0.002). In addition, insertion-related complications, particularly kinking and overall adverse events, occurred less frequently in the Reverse Sellick’s group.

Conclusion: From a clinical perspective, the combination of improved success rates, reduced procedure time, and lower complication rates makes this technique particularly useful in the operating room setting, where efficiency and patient safety are paramount. Fewer attempts and shorter insertion times may also reduce mucosal injury and bleeding.