Selective naso/orogastric decompression

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JWebar

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Hey there...
This may be a stupid question but after reading that "selective" nasogastric decompression results in fewer pulmonary postoperative complications I've wandering... In which ELECTIVE cases will you do this? In my center we do it for virtually all abdominal cases, especially if they are laparoscopic (nasogastric tube after intubation, suction and then leave it for the entire surgery. Before emergence suction again and then take it out). The surgeons usually dont ask us to do it, its just routine. Do you do the same?

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In my center we do it for virtually all abdominal cases, especially if they are laparoscopic (nasogastric tube after intubation, suction and then leave it for the entire surgery. Before emergence suction again and then take it out).
If the tube is going to come out at the end of the procedure, put an orogastric tube in, not a nasogastric one. Easier and you won't bloody up the patient's nose.

Most of our surgeons want one in for laparoscopic cases. I'll also put one in for elective cases in diabetics, most inpatients, anyone who's got a reason for decreased gastric emptying, even if NPO. Easy and low risk and I'm often surprised how much an empty stomach has in it. Although, if the tube doesn't go in easy, I don't keep trying.
 
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Agreed with most of your answers. How about laprascopic inguinal hernia repairs? I have been on the fence about placing OG tubes for those cases. I know that the ones I have done roughly 30 half the time the surgeon places a verus needle into the abdomen to decrease the pressure in peritoneal cavity. Which in case if the intrabdominal space has air in it then I need to decompress the stomach with an OG tube. Incidentally enough I have found the CO2 washin from insuffilating the inguinal cavity is far greater and less buffered then when during laprascopic abdominal surgery. Perhaps the greatest amount of blood filled with CO2 washes into the liver? and is buffered there? Preperitoneal structures have more micro-vasculature?
 
Surprised by the answers here, i never do it but maybe i should..? I only place one when it's going to stay post-op (which by the way increases the risk of pulminary complications) what's the evidence on the subject?
 
Dude. This is easy.

If you did an RSI, evacuate the stomach.

If you're doing an abdominal procedure, decompress the stomach. Especially if laparoscopic, especially if foregut, especially if you're using nitrous.

If it's just a long surgery, consider emptying the stomach.

In general, prefer the orogastric route over the nasogastric.

If it's difficult, try 2 or 3 times then give up. No biggie.

If they're definitely going to the ICU intubated, leave the tube. If they're definitely gonna have a gastric tube postop (rare), use the nose.
 
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