Nasogastric tubes and cricoid pressure

Vanner, R. G.; Pryle, B. J.

doi:10.1111/j.1365-2044.1993.tb07560.x

Cited by 52 publications

(7 citation statements)

References 5 publications

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“…1,97,98 Surprisingly, despite its wide acceptance, the efficacy and effectiveness of CP in preventing aspiration has remained unproven and spawned debate as to its role in emergency airway management. 1,[99][100][101][102] Evidence affirming a role for CP in preventing aspiration is unavailable. 1,98,100 Its continued use during RSI is based on anecdotal evidence and expert opinion; it has likely achieved the status of standard of care and it is unlikely that a large RCT will be forthcoming that assesses its role in high-risk patients.…”

Section: Should Cricoid Pressure Be Used Routinely In All Patients Unmentioning

confidence: 99%

“…102 In a subsequent report, cervical computed tomography scans of normal patients were reviewed to assess the anatomic relationships between the cricoid cartilage and the esophagus; lateral esophageal displacement relative to the cricoid cartilage was evident in half (25 of 51) of the patients studied; 64% of these individuals had esophageal displacement beyond the lateral border of the cricoid cartilage. 103 A later evaluation in 22 volunteers using magnetic resonance imaging reported that the esophagus was laterally displaced relative to the cricoid cartilage in 52.6% of the subjects; this proportion increased to 90.5% with the application of CP.…”

Section: Should Cricoid Pressure Be Used Routinely In All Patients Unmentioning

confidence: 99%

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No evidence for decreased incidence of aspiration after rapid sequence induction

Neilipovitz

Crosby

2007

Can J Anesth/J Can Anesth

150

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Purpose:The purpose of this structured, evidence-based, clinical update was to determine if rapid sequence induction is a safe or effective technique to decrease the risk of aspiration or other complications of airway management. Source:In June 2006 a structured search of MEDLINE from 1966 to present using OVID software was undertaken with the assistance of a reference librarian. Medical subject headings and text words describing rapid sequence induction or intubation (RSI), crash induction or intubation, cricoid pressure and emergency airway intubation were employed. OVID's therapy (sensitivity) algorithm was used to maximize the detection of randomized trials while excluding non-randomized research. The bibliographies of eligible publications were hand-searched to identify trials not identified in the electronic search. Principal findings:A total of 184 clinical trials were identified of which 163 were randomized controlled trials (RCTs). Of these clinical trials, 126 evaluated different drug regimens with 114 being RCTs. Only 21 clinical trials evaluated non-pharmacologic aspects of the RSI with 18 RCTs identified. A parallel search found 52 trials evaluating cricoid pressure (outside of the context of an RSI technique) with 44 classified as RCTs. Definitive outcomes such as prevention of aspiration and mortality benefit could not be evaluated from the trials. Likewise, the impact on adverse outcomes of the different components of RSI could not be ascertained. Conclusion:An absence of evidence from RCTs suggests that the decision to use RSI during management can neither be supported nor discouraged on the basis of quality evidence.

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Section: Should Cricoid Pressure Be Used Routinely In All Patients Unmentioning

confidence: 99%

Section: Should Cricoid Pressure Be Used Routinely In All Patients Unmentioning

confidence: 99%

No evidence for decreased incidence of aspiration after rapid sequence induction

Neilipovitz

Crosby

2007

Can J Anesth/J Can Anesth

150

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“…However, Vanner and Pryle[8] on studying computed tomography (CT) scans during application of CP, demonstrated lateral displacement of esophagus. In agreement with this finding, a retrospective review of 51 cervical CT scans[9] and prospective analysis of 22 cervical magnetic resonance imaging (MRI) scans,[10] revealed some degree of lateral displacement of the esophagus relative to the midline of the vertebral body in 49% and 53% respectively, even in the absence of any CP.…”

Section: Does Cp Occlude the Esophagus?mentioning

confidence: 99%

Cricoid pressure: Where do we stand?

Bhatia

Bhagat

Sen

2014

J Anaesthesiol Clin Pharmacol

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In 1961, Sellick popularized the technique of cricoid pressure (CP) to prevent regurgitation of gastric contents during anesthesia induction. In the last two decades, clinicians have begun to question the efficacy of CP and therefore the necessity of this maneuver. Some have suggested abandoning it on the grounds that this maneuver is unreliable in producing midline esophageal compression. Moreover, it has been found that application of CP makes tracheal intubation and mask ventilation difficult and induces relaxation of the lower esophageal sphincter. There have also been reports of regurgitation of gastric contents and aspiration despite CP. Further, its effectiveness has been demonstrated only in cadavers; therefore, its efficacy lacks scientific validation. These concerns with the use of CP in modern anesthesia practice have been briefly reviewed in this article.

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“…ст. [29]. К относительным и абсолютным противопо казаниям для применения давления на перстне видный хрящ относятся рвота, затрудненная вен тиляция и травма гортани.…”

Section: гиперэргический аспирационный пневмонитunclassified

Hyperergic Aspiration Pneumonitis (Mendelson Syndrome)

Shifman¹

2006

rmt

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Nasogastric tubes and cricoid pressure

Cited by 52 publications

References 5 publications

No evidence for decreased incidence of aspiration after rapid sequence induction

No evidence for decreased incidence of aspiration after rapid sequence induction

Cricoid pressure: Where do we stand?

Hyperergic Aspiration Pneumonitis (Mendelson Syndrome)

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