IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 14, Issue 8 Ver. VI (Aug. 2015), PP 57-60 www.iosrjournals.org DOI: 10.9790/0853-14865760 www.iosrjournals.org 57 | Page A Rail-Road Technique of Ryle’s Tube/Nasogastric Tube Insertion in an Intubated Patient: A Case Report Yogesh Rathod 1 , Suyog Bagade 1 , Pratiksha Sagare 1 , Nirav Kotak 2 , R D Patel 3 . 1 Student, MD Anaesthesia 3 rd year, Department of Anaesthesiology and Critical Care, Seth G S Medical College & KEM Hospital, Mumbai, India. 2 Associate Professor, Department of Anaesthesiology and Critical Care, Seth G S Medical College & KEM Hospital, Mumbai, India. 3 Professor, Department of Anaesthesiology and Critical Care, Seth G S Medical College & KEM Hospital, Mumbai, India. Abstract : Insertion of a nasogastric tube in an unconscious intubated patient may be difficult as they cannot follow the swallowing instructions, and therefore has a high first attempt failure rate. The use of nasogastric tube is desirable for some surgical procedures to keep stomach deflated (like laparoscopic surgeries) or for the short term administration of feeds post-operatively. We had a thirty five-year-old male who was posted for laparoscopic cholecystectomy. Surgery demanded Ryle’s tube insertion after creating pneumo-peritoneum because inflated stomach was obscuring their view. We tried for Ryle’s tube insertion in our patient through both nostrils but failed. So with the help of Rail-road technique using another endotracheal tube, infant feeding tube/ suction catheter and Magill’s forceps we successfully inserted the nasogastric tube without any oropharyngeal trauma to the patient. Patient was hemodynamically stable throughout the procedure. Keywords – Nasogastric tube (Ryle’s tube), Endotracheal tube, Infant feeding tube/Suction catheter, Magill’s forceps, Rail-road technique I. Introduction Nasogastric (NG) tube insertion is used to deliver nutrition or medication in hospital wards and intensive care units, in operating room intra-operatively and post-operatively too. Patient cooperation by swallowing on instruction while inserting an NG tube is important. So inserting a NG tube in an awake patient is not much difficult. But in an intubated patient, inserting a NG tube is little difficult as we can ’t instruct an unconscious and intubated patient to swallow. So there are high first attempt failure rates (nearly 50%) while inserting a NG tube in an intubated patient. Also after each unsuccessful insertion attempt, incidences of mucosal bleeding and hemodynamic complication increase. We devised a new technique (Rail-road technique ) to insert NG tube in such patients. II. Case Report A 35 year old male with 60kg weight, classified under ASA I of American Society of Anesthesiology classification, with no any previous significant medical or surgical history was posted for Laparoscopic cholecystectomy in view of cholelithiasis. Patient is a chronic alcoholic and tobacco chewer since 5-6 years. Patient has adequate neck movements with mouth opening of >3 fingers of her own, Mallampatti Classification Grade I with thyro-mental distance of approximately 6 cm. 1. General examination: Patient was conscious, oriented with time place and person, Pulse: 92/min, Blood Pressure: 140/83 mm of Hg, 2. Systemic Examination: 2.1 Cardiovascular System: S1S2 Heard, no murmur, 2.2 Respiratory system: Air entry bilaterally equal and clear, 2.3 Central nervous system: conscious and oriented 3. Investigations: Hb-14.2 gm%, TLC-8600/cmm, platelets were 4.14 lacs/cmm