Comparison Between the Reverse Sellick’s and SORT Manoeuvres of Nasogastric Tube Insertion in Anaesthetised, Intubated, Adult Patients- A Randomised Clinical Study

Abstract

Introduction: In the perioperative period and critical care unit, nasogastric tube (NGT) placement is a simple procedure which turns in to a difficult one in anaesthetized, intubated patient. The SORT manoeuvre (a combination of Sniffing position, Orientation of nasogastric tube, Rotating the patient’s head to the contralateral side, and Twisting movements of operator’s hand) has been studied sparingly. Reverse Sellick’s manoeuvre is a commonly applied method for NGT placement where cricoid cartilage is lifted by the performer with non-dominant hand during placement of NGT. Aim: To ascertain the success rate of SORT manoeuvre in comparison with the reverse Sellick’s manoeuvre for NGT placement in anaesthetized and intubated adults. Materials and Methods: This single-blinded, randomised study was conducted in N.R.S. Medical College and Hospital (tertiary care centre), Kolkata, West Bengal, India, from March 2020 to August 2021. Total 102 adults patients, scheduled for abdominal surgeries under general anaesthesia with intubation, were included. The patients received NGT placement either by applying reverse Sellick’s manoeuvre (group A, n=51) or using SORT manoeuvre (group B, n=51), following a random allocation method. The number and percentage of patients having successful NGT placement within first attempt in each group was recorded. The time to perform the procedure and any incidence of adverse event were recorded. Quantitative variables were compared using Independent t-test between the two groups. Qualitative variables were compared using Chisquare test/Fisher’s exact test, as appropriate. A p-value ≤0.05 was considered statistically significant. Results: Successful placement of NGT within single attempt was feasible in 48 patients (94.2%) using the SORT manoeuvre in contrast with 38 (74.5%) applying the reverse Sellick’s manoeuvre (p-value=0.006). Longer procedure time was observed with the SORT manoeuvre compared to the reverse Sellick’s manoeuvre (22.3±4.4 vs 20.1±3.8 seconds), respectively; p-value=0.008). Use of SORT manoeuvre in comparison with reverse Sellick’s manoeuvre resulted in apparently lower incidence of adverse events (Coiling 1.96% vs 19.6%; Kinking 1.96% vs 3.92%, respectively); however, found statistically not significant (p-value=0.305). However, overall incidence of adverse events was considerably more in reverse Sellick’s manoeuvre compared with the SORT manoeuvre (25.5 % and 5.8%, respectively, p-value=0.006). Conclusion: The SORT manoeuvre appears to be advantageous over the reverse Sellick’s manoeuvre for NGT placement in adult patients undergoing surgery under general anaesthesia with intubation, in terms of higher success rate and lower incidence of adverse events.