Inadvertent intrabronchial misplacement of nasogastric tube in an intubated patient

抄録

　Inadvertent insertion of a nasogastric tube (NGT) into the trachea and distal airway can sometimes occur in intubated patients during general anesthesia, and there are usually several signs leading to the suspicion of misplacement. I report a case of intrabronchial misplacement of an NGT without definite signs of malposition. The patient was 41-year-old man who underwent laparoscopic cholecystectomy under general anesthesia. After anesthetic induction, an NGT was inserted from the left naris and advanced without resistance. A gurgling sound could be heard over the left epigastrium by injecting air, and serous liquid was suctioned from the NGT. There were no definite signs of NGT malposition initially. However, intrabronchial misplacement was suspected because of synchronized movement of a disposable glove attached to the proximal end of NGT with mechanical ventilation at the end of the operation, and confirmed by chest radiography postoperatively. In conclusion, inadvertent intrabronchial misplacement of an NGT in an intubated patient can occur without definite signs during general anesthesia, in which a neuromuscular blocking agent is administered. In such situations, the potential of intrabronchial misplacement should be constantly borne in mind. And the proper positioning of NGT should be rechecked carefully at the slightest hint of trouble by changing the position of NGT or by confirming with direct laryngoscopic exposure.