Facilitation of tracheal intubation by cephalad displacement of the larynx—rediscovered

Mr, Salem; Hj, Heyman; M, Mahdi

doi:10.1016/0952-8180(94)90024-8

Cited by 8 publications

(1 citation statement)

References 6 publications

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“…57 It is also possible to combine cricoid pressure together with optimal external laryngeal manipulation. 58,59 Cricoid pressure is effective in sealing the oesophagus around the nasogastric tube 60,61 and it is not necessary to remove any inserted nasogastric tube before RSI. The nasogastric tube should not be blocked as the unoccluded tube can then act as a "blow-off" valve to relieve any pressure built up in the stomach.…”

Section: Cricoid Pressurementioning

confidence: 99%

Rapid Sequence Induction and Intubation

2001

Hong Kong Journal of Emergency Medicine

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The modern version of RSI starts with preoxygenation. General anaesthesia is then induced using a rapid acting intravenous anaesthetic and a rapid acing muscle relaxant. Cricoid pressure is applied by an experienced assistant during induction, which should then be maintained until the trachea of the patient is intubated, correct positioning of the tracheal tube confirmed and the cuff inflated. The patient is conventionally not ventilated during this phase but critically ill patients are exceptions. The patient's tracheal should be intubated when adequately paralysed and its position verified. The assistant can then relieve the cricoid pressure and the tracheal tube fixed.

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Section: Cricoid Pressurementioning

confidence: 99%

Rapid Sequence Induction and Intubation

2001

Hong Kong Journal of Emergency Medicine

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Cricoid pressure

1997

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MS CI-IB FRCA Purpose: Although crico~d pressure (CP) is a superficially simple and appropriate mechanical method to protect the patient from regurgitation and gastric insuffiation, in practice it is a complex manoeuvre which is difficult to perform optimally. The purpose of this review is to examine and evaluate studies on the application of (CP). It deals with anatomical and physiological considerations, techniques employed, safety and efficacy issues and the impact of CP on airway management with special mention of the laryngeal mask airway.Source of material: Three medical databases (48 Hours, Medline, and Reference Manager Update) were searched for citations containing key words, subject headings and text entries on CP to October 1996.Principle Findings: There have been no studies proving that CP is beneficial, yet there is evidence that it is often ineffective and that it may increase the risk of failed intubation and regurgitation. After evaluation of all available data, potential guidelines are suggested for optimal use of CP in routine and complex situations.Conclusions: If CP is to remain standard practice during induction of anaesthesia, it must be shown to be safe and effective. Meanwhile, further understanding of its advantages and limitations, improved training in its use, and guidelines on optimal force and method of application should lead to better patient care.Objectif : Bien qu'elle salt une m&hocle m&anique en apparence simple et appropnEe ex&utEe pour protEger contre la regurgitation et I'insufflation gastrique, la compression du cricoide (CC), en pratique, constitue une manoeuvre complexe et difficile ~ rEaliser parfaitement. Cette revue vise I'analyse et I'Evaluation des Etudes publiEes sur son usage, Elle porte sur les considerations anatomiques et physiologiques, les techniques utilisEes, les probl~mes de sEcuritE et d'eflicacitE et I'impact de la CC sur la gestion des voles aEriennes avec une attention spEciale envers le masque laryngE. Sara'c 9 : Trois bases de donnEes mEdicaies (48 Hours, Medline et Reference Manager Update) ant EtE scrutEes au regard des citations contenant les mats des, les titres des sujets et les entr~es de texte concemant la CC lusqu'au mois d'octobre 1996.Principales constatations 9 Aucune Etude n'a prouvE les bienfaits de la CC, alors qu'il est dEmontr~ qu'elle est souvent inefficace et qu'elle peut augmenter l'incidence des intubations EchouEes et des regurgitations. Apr~s une Evaluation de toutes les donnEes disponibles, des lignes de conduites sont suggErEes en vue d'une pratique optimale de la CC dans les situations courantes et complexes.Conclusions : Si la CC dart demeurer une manoeuvre standard pendant l'induction de l'anesthEsie, il faut faire la preuve qu'elle est sore et efficace. En attendant, une meilleure comprehension de ses avantages et de ses limitations, un enseignement amEliorE et des donnEes plus pr&ises sur la pression exercEe idEale et son mode d'utilisation devraient nous aider ~ foumir de meilleurs soins. RICOID pressure (CP) has been des...

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The “BURP” maneuver worsens the glottic view when applied in combination with cricoid pressure

Snider

Clarke

Finucane

2005

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : The purpose of this study was to determine if the application of a BURP maneuver to the cricoid cartilage would combine the benefits of both the BURP and the Sellick maneuvers, resulting in an improved glottic view and offer the potential of protection against passive gastric regurgitation.M Me et th ho od ds s: : This was a double-blind, prospective, randomized, crossover trial. Forty-three patients scheduled for elective surgery participated in this study. General anesthesia was induced using fentanyl, propofol and rocuronium. In a random sequence for each case and blinded to the laryngoscopist, one of three maneuvers was carried out. Direct vertical pressure, using 30 newtons, a BURP maneuver with cricoid pressure, or no pressure was applied to the cricoid and the laryngoscopic view was ascertained. A separate laryngoscopy was conducted for each maneuver and the views were graded as good (part of the glottis seen), poor (only the arytenoids were seen) or no view (only the epiglottis was seen). Endotracheal intubation was then performed in each case. R Re es su ul lt ts s: :The results showed that the combination of the BURP maneuver and cricoid pressure worsened the view obtained at laryngoscopy in 30% of cases (P = 0.007). Cricoid pressure alone worsened the view in 12.5% of cases (P = 0.279). No difference was seen in 65% of cases. All patients but one were intubated easily.C Co on nc cl lu us si io on n: : There is no benefit to routinely applying a modified "BURP" maneuver to the cricoid cartilage during rapid sequence induction of anesthesia.

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Facilitation of tracheal intubation by cephalad displacement of the larynx—rediscovered

Cited by 8 publications

References 6 publications

Rapid Sequence Induction and Intubation

Rapid Sequence Induction and Intubation

Cricoid pressure

The “BURP” maneuver worsens the glottic view when applied in combination with cricoid pressure

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