To the Editor:—
The presence of a nasogastric tube may make mask ventilation difficult. We found that the use of a denture adhesive (Tafugurippu®; Kobayashi Pharmaceutical Co., Ltd., Osaka, Japan) around the nasogastric tube reduced the gas leak (fig. 1).
We also conducted a brief study to evaluate the effectiveness of this technique during positive-pressure ventilation in volunteers.
After approval from the review board of Chikuho Rosai Hospital, Fukuoka, Japan, and informed consent were obtained, we studied 20 surgical patients (American Society of Anesthesiologists physical status I or II; aged between 51 and 83 yr) with normal airways. Anesthesia was induced with propofol, and the patient was paralyzed with vecuronium. An inflatable face mask (King Systems Co., Noblesville, IN) was applied on the face, and the airway was secured by triple-airway maneuver. The lungs were inflated with a ventilator (7800 ventilator; Ohmeda, Tokyo, Japan) in the volume control mode (10 ml/kg), with a frequency of 12/min and an inspiratory/expiratory ratio of 1:2. Expiratory tidal volumes were recorded from the 6th to the 10th breath. A 16-French-sized nasogastric tube (SF-GX1620; TERUMO, Tokyo, Japan) then was inserted into the right nostril, and the nasogastric tube was placed out, with the proximal end exiting under the right lateral part of the mask. The expiratory tidal volumes were measured in the same manner. Next, the gas leak between the nasogastric tube and the cushion of the mask was covered with the denture adhesive, without changing tube position (fig. 1). Tidal volumes then were measured in the same manner and expressed as a percentage of the volume measured before nasogastric tube insertion.
With the nasogastric tube in place, expired tidal volume was 52 ± 13% of that recorded before tube insertion. When the denture adhesive was applied, expired tidal volume increased to 71 ± 12% of the control value (P < 0.001 vs. value obtained before application of the adhesive; paired t test). The use of denture adhesive clearly reduced the gas leak around the nasogastric tube and may offer some advantages in cases when anesthesia must be induced or managed in individuals with such devices in situ .