Comparative Study to Evaluate Ease of Nasogastric Tube Insertion in Intubated Patients with Three Different Techniques

Background: Nasogastric tube (NGT) insertion in anaesthetized and intubated patients is often challenging due to altered airway anatomy and decreased muscle tone. Several bedside techniques have been described to facilitate smooth insertion, but evidence directly comparing commonly practiced methods remains limited. Aim and Objective: To compare the ease of NGT insertion using three techniques—additional neck flexion, standard sniffing position with lateral neck pressure, and reverse Sellick’s manoeuvre—in intubated adult patients undergoing elective surgeries. Materials and Methods: This prospective, randomized comparative study included 120 adult patients (ASA I– II) undergoing elective surgery under general anaesthesia. Patients were allocated into three groups (n = 40 each): Group A Additional neck flexion, Group B—standard sniffing position with lateral neck pressure, and Group C—reverse Sellick’s manoeuvre. The primary outcomes assessed were number of attempts and time required for successful NGT insertion. Secondary outcomes included hemodynamic changes and complications such as kinking, coiling and nasal bleeding. Results: Baseline demographic and clinical characteristics were comparable across all groups. Group A demonstrated the highest first-attempt success rate and the shortest insertion time. Group B showed moderate ease of insertion, while Group C had the lowest first-attempt success and longest insertion time. Complications were least frequent in Group A and most common in Group C. Hemodynamic parameters remained stable in all groups, and no major adverse events occurred. Conclusion: Additional neck flexion is the most effective technique for NGT insertion in intubated patients, offering superior first-attempt success, shorter insertion time, and fewer complications compared with lateral neck pressure and reverse Sellick’s manoeuvre. Its simplicity and safety make it a preferred method in routine anaesthetic practice.