SummaryThis study aimed to evaluate whether the application of cricoid pressure at the time of induction of anaesthesia was associated with a lesser incidence of postoperative nausea or vomiting in the immediate postoperative period compared with a group in which no cricoid pressure was applied, in patients undergoing day care gynaecological laparoscopy. One hundred ASA I and II females were randomly allocated to receive cricoid pressure at the time of induction. The peri-operative anaesthetic technique was standardised. The incidence of postoperative nausea and vomiting in the group who received cricoid pressure was 16% in the recovery room compared with 26% in the no cricoid group. When the period was extended to the ®rst 6 h post anaesthesia the incidence was 30% in the cricoid and 44% in the no cricoid group. This difference did not achieve statistical signi®cance in either period (p b 0.05). The results suggest that application of cricoid pressure at the time of induction does not signi®cantly alter the incidence of postoperative nausea and vomiting in the ®rst 6 h of recovery from anaesthesia. Keywords Vomiting; nausea, incidence. Larynx; cricoid pressure. Several factors can in¯uence the incidence of postoperative nausea and vomiting (PONV) after gynaecological surgery. These are age, body weight, type of surgery, anaesthetic agents and anaesthetic techniques [1]. Gastric distension as a result of positive pressure ventilation with a facemask has been suggested as one of the causes of PONV [2].Cricoid pressure, although originally designed to prevent regurgitation in the period between induction of anaesthesia and insertion of a tracheal tube [3], is also effective in preventing in¯ation of the stomach with air in both adults and children [4, 5].The aim of this study was to ®nd out whether cricoid pressure application at the time of induction offered any protection against nausea and vomiting in the immediate recovery period, in day care patients undergoing diagnostic gynaecological laparoscopy.
MethodsThe study protocol was approved by the ethics committee of the Aga Khan University Hospital. One hundred patients of ASA status I and II, aged 18±45 years, were enrolled in the study. Exclusion criteria included any previous history of PONV or motion sickness, a dif®cult airway, weight b 80 kg or receipt of concomitant medications that could interfere with the evaluation of the results. All patients were undergoing elective diagnostic gynaecological laparoscopy and informed consent was obtained before enrolment. They were randomly assigned to one of two groups; group C consisted of those patients who had cricoid pressure application at the time of induction of anaesthesia and group NC consisted of those patients in whom no cricoid pressure was applied. Patients were premedicated with midazolam 7.5 mg orally given , 1 h prior to anaesthesia. Pre-oxygenation was with three vital capacity breaths of 100% oxygen. All patients then received pethidine 0.8 mg.kg À1 . Intravenous induction was with thiopental 4±5 m...