Cricoid Cartilage Pressure Decreases Lower Esophageal Sphincter Tone

Tournadre, JP; Chassard, D.; Berrada, Khalid; Boulétreau, P

doi:10.1097/00000542-199701000-00003

Cited by 96 publications

(50 citation statements)

References 17 publications

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“…2 This technique has become the cornerstone of rapid sequence induction of anesthesia. Although the efficacy and hence the necessity of this maneuver has been questioned, 3,4 its use continues to be recommended by airway guideline developers. In a recent editorial, Dr. Lerman points out that ''currently, there is insufficient evidence to advocate or abandon the use of cricoid pressure to prevent passive regurgitation in at-risk anesthetized patients.''.…”

Section: Résumémentioning

confidence: 99%

Cricoid pressure with the Truview Evo2TM laryngoscope improves the glottic view

Kumar

Behera

Dali

et al. 2011

Can J Anesth/J Can Anesth

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Objective The Truview Evo2TM laryngoscope blade is designed to improve glottic view. This study was designed to evaluate the effect of cricoid pressure (CP) on laryngeal view and the ease of orotracheal intubation with the Truview Evo2 laryngoscope. Methods In this randomized controlled trial, 50 patients (American Society of Anesthesiologists physical status I-II, aged 18 to 60 yr) scheduled for elective surgery were enrolled. After induction of anesthesia and muscle paralysis, laryngoscopy was performed using the Truview Evo2 TM laryngoscope with the patient's head in the neutral position. In Group 1, the percentage of glottic opening (POGO) score was evaluated first without CP, then with CP, and CP was applied for intubation. In Group 2, the POGO score was evaluated first with CP, then without CP, and no CP was applied for intubation. Time to intubation and number of attempts required for intubation were also recorded. Results In 50 patients, the mean (standard deviation) POGO view obtained with the application of CP was 93% (10%) compared with 81% (19%) in patients without CP (P \ 0.01). Times to intubation were similar in the two groups: 14.2 (6.6) sec vs 14.0 (9.3) sec in Groups 1 and 2, respectively (P = 0.924). Sixteen percent of patients in Group 1 required a second attempt at tracheal intubation, while only 4% of patients in Group 2 required a second attempt (P = 0.162). Conclusion When using the Truview Evo2TM laryngoscope with the patient's head in the neutral position, application of CP improves the glottic view. This approach is not associated with increased difficulty in intubation.

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Section: Résumémentioning

confidence: 99%

Cricoid pressure with the Truview Evo2TM laryngoscope improves the glottic view

Kumar

Behera

Dali

et al. 2011

Can J Anesth/J Can Anesth

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“…No entanto, durante o vômito, quando a pressão esofágica pode ser superior a 60 cmH 2 O, a manobra deve ser suspensa, pois pode haver ruptura esofágica. A compressão da cartilagem cricóide aumenta o tônus do esfíncter esofágico superior 14 , mas diminui o do inferior 15 , o que sugere a presença de mecanorreceptores na faringe que promoveriam relaxamento reflexo desse esfíncter. Esse efeito, porém, parece não provocar refluxo gastroesofágico 16 .…”

Section: Pressão Intragástricaunclassified

“…However, during vomiting, when esophageal pressure can be higher than 60 cmH 2 O, the maneuver should be discontinued due to the risk of esophageal rupture. Applying pressure on the cricoid cartilage increases the tonus of the upper esophageal sphincter 14 , but decreases the tonus of the lower esophageal sphincter 15 , suggesting the presence of mechanoreceptors in the pharynx that promote relaxation of this sphincter. However, this effect does not seem to cause gastroesophageal reflux 16 .…”

Section: Intragastric Pressurementioning

confidence: 99%

Compressão da cartilagem cricóide: aspectos atuais

Moro¹,

Goulart²

2008

Rev. Bras. Anestesiol.

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Rev Bras AnestesiolARTIGO DE REVISÃO 2008; 58: 6: 643-650 REVIEW ARTICLE RESUMO Moro ET, Goulart A -Compressão da Cartilagem Cricóide. Aspectos Atuais. JUSTIFICATIVA E OBJETIVOS:Sellick descreveu a importância da pressão aplicada na cartilagem cricóide para a prevenção da regurgitação do conteúdo gástrico durante a indução da anestesia. Desde então a manobra tem sido universalmente aceita pelos anestesiologistas como um passo fundamental durante a indução com a técnica de seqüência rápida. O presente artigo teve como objetivo discutir as indicações, a técnica, as complicações e os motivos pelos quais alguns autores têm contestado a eficácia dessa técnica. CONTEÚDO:Foram revisadas as indicações, a técnica e as complicações da manobra de compressão da cartilagem cricóide. Também foram discutidos os aspectos que têm motivado alguns autores a abandonar a manobra de Sellick durante a indução anestésica com a técnica de seqüência rápida. CONCLUSÕES:A aplicação da manobra de compressão da cartilagem cricóide exige o conhecimento da anatomia da via aérea superior e da força correta a ser empregada. Estudos endoscópicos e radiológicos, assim como pacientes que apresentaram aspiração pulmonar a despeito da aplicação da manobra de Sellick, têm colocado em questão a utilidade da técnica. Além disso, quando mal empregada, pode causar deformidade dessa cartilagem, fechamento das cordas vocais e dificuldade de ventilação. Apesar do papel de destaque representado pela manobra de Sellick na prevenção da aspiração pulmonar, não há garantia de proteção das vias aéreas para todos os pacientes, sobretudo quando a técnica não é corretamente aplicada.

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“…Salem et al further demonstrated that application of cricoid pressure during bag mask ventilation in pediatric patients prevents gastric inflation and thus also help in preventing regurgitation and aspiration [3] . The efficacy of cricoid pressure in prevention of aspiration has been doubted in the last 20 years and has been questioned by clinicians, with few suggesting abandoning this maneuver altogether [4,5] . Anecdotal case reports of regurgitation despite cricoid pressure being applied incited the debate whether cricoid pressure is really effective or just a 55 year old ritual [6] .…”

Section: Introductionmentioning

confidence: 99%