Aspiration and nasogastric intubation.

Routine use of nasogastric tubes in major surgery is associated with unwarranted risks of aspiration through at least three mechanisms: hypersalivation--allowing pooling of secretions in the hypopharynx, a depressed cough reflex, which is often associated with nasogastric intubation, and various laryngeal and pharyngeal abnormalities that are frequently caused by nasogastric tubes, leading to an inability to handle secretions and protect the airway. Using indirect cinelaryngoscopy, we can accurately document these mechanisms; three representative cases are presented here. Aspiration associated with nasogastric intubation is a newly described but potentially serious complication. Routine use of nasogastric intubation should be abandoned, except when the clinical situation warrants it.