Cricoid pressure: The argument against

Cricoid pressure: apply - but be ready to release

“…There is little doubt that CP interacts with all aspects of airway management, even when properly applied in the relevant studies . It may increase inspiratory pressures, reduce tidal volumes, and result in partial or even complete airway occlusion .…”

“…The mechanics also appear straightforward: compress the cricoid ring against the sixth cervical vertebra, thereby occluding the upper oesophageal lumen . Yet, debates continue , centered around some core questions : What is the risk of pulmonary aspiration during anaesthetic induction? Does CP prevent regurgitation (i.e, reflux from upper oesophagus into laryngopharynx), and hence aspiration? Does CP occlude the oesophagus? …”

Obstetric tracheal intubation guidelines and cricoid pressure

“…Cricoid pressure was introduced into clinical practice in 1961, based on a small case series without any exact information on the cricoid forces that were applied and the type of induction of anaesthesia . Subsequently, not a single controlled clinical study provided convincing evidence that the use of cricoid pressure was associated with a reduced risk of pulmonary aspiration . At the same time, there is good evidence that nearly all aspects of airway management are adversely affected by cricoid pressure .…”

“…Subsequently, not a single controlled clinical study provided convincing evidence that the use of cricoid pressure was associated with a reduced risk of pulmonary aspiration . At the same time, there is good evidence that nearly all aspects of airway management are adversely affected by cricoid pressure .…”

“…single case‐control or historical‐control study ) published in peer‐reviewed scientific literature a sine qua non criterion for equipment evaluation . As recently pointed out , if cricoid pressure were considered a new airway device, it would not be considered for further evaluation because Level 3B evidence for its efficacy does not exist.…”