Regurgitation and oesophageal rupture with cricoid pressure: a cActaver study

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

doi:10.1111/j.1365-2044.1992.tb03248.x

Cited by 159 publications

(95 citation statements)

References 13 publications

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“…In the UK, it is generally accepted that a force of 20 N should be applied to the cricoid cartilage in the awake patient [2], increasing to at least 30 N with loss of consciousness to prevent regurgitation [2,8,9]; laryngoscopic view and airway patency are best maintained if cricoid force is kept below 44 N [2,9]. The application of cricoid force has therefore become central to techniques that aim to reduce the risk of regurgitation and subsequent inhalation associated with obstetric and emergency anaesthesia.…”

Section: Discussionmentioning

confidence: 99%

“…Cricoid force may be inadequately or incorrectly applied, with subsequent morbidity and mortality [4], even among trained personnel [5,6]. There is debate about the optimal cricoid force required during induction of anaesthesia [2,[7][8][9][10], but it has been demonstrated that accurate, sustainable force can be delivered by using a cricoid yoke, even after minimal operator training [11,12].…”

Section: Introductionmentioning

confidence: 99%

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The effect of mechanically‐induced cricoid force on lower oesophageal sphincter pressure in anaesthetised patients

et al. 2004

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SummaryIn the United Kingdom, cricoid force is central to upper airway management in obstetric and emergency anaesthesia. A reduction in oesophageal barrier pressure (OBP) in these patients may increase regurgitation risk. This study investigated whether the application of cricoid force to anaesthetised patients reduced lower oesophageal sphincter pressure (LOSP) and consequently OBP. Anaesthesia was induced in 29 patients using a standard protocol. An oesophageal balloon catheter was inserted and gastric trace identified. The catheter was withdrawn incrementally and pressure readings recorded at each position before and during the application of 30 N cricoid force, with a sudden rise in pressure indicating lower oesophageal sphincter position. Oesophageal barrier pressure was calculated as the difference between LOSP and gastric pressure. Application of cricoid force significantly reduced OBP without influencing gastric pressure (p < 0.001). The use of cricoid force may increase the risk of gastroesophageal reflux in anaesthetised patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The effect of mechanically‐induced cricoid force on lower oesophageal sphincter pressure in anaesthetised patients

et al. 2004

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“…Cricoid pressure may be responsible for airway obstruction; a previous study has shown that cricoid pressure, with an unmeasured force, can cause airway obstruction in Ϸ 10% of cases [4]. A force of Ϸ 44 N was applied to the cricoid cartilage in that study, although a force of 30 N is adequate to prevent regurgitation [5]. A new technique has been described whereby cricoid pressure is applied in an upward and backward direction to improve the view at laryngoscopy [6] but it is not known whether this causes airway obstruction.…”

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confidence: 90%

Airway obstruction with cricoid pressure

2000

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SummaryCricoid pressure may cause airway obstruction. We investigated whether this is related to the force applied and to the technique of application. We recorded expired tidal volumes and inflation pressures during ventilation via a facemask and oral airway in 52 female patients who were anaesthetised and about to undergo elective surgery. An inspired tidal volume of 900 ml was delivered using a ventilator. Ventilation was assessed under five different conditions: no cricoid pressure, backwards cricoid pressure applied with a force of 30 N, cricoid pressure applied in an upward and backward direction with a force of 30 N, backwards cricoid pressure with a force of 44 N and through a tracheal tube. An expired tidal volume of < 200 ml was taken to indicate airway obstruction. Airway obstruction did not occur without cricoid pressure, but did occur in one patient (2%) with cricoid pressure at 30 N, in 29 patients (56%) with 30 N applied in an upward and backward direction and in 18 (35%) patients with cricoid pressure at 44 N. Cricoid pressure applied with a force of 44 N can cause airway obstruction but if cricoid pressure is applied with a force of 30 N, airway obstruction occurs less frequently (p ¼ 0.0001) unless the force is applied in an upward and backward direction.

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“…It involves the application of backward pressure on the cricoid cartilage with a force of between 30 and 40 N [1][2][3][4][5] in order to occlude the upper oesophagus (although latterly it has been suggested that a force of 20-30 N [6][7][8] might be more appropriate). Failure to secure the airway in this way may put the patient at risk of developing aspiration pneumonitis, bacterial pneumonia and or bronchial blockage [9].…”

Section: Introductionmentioning

confidence: 99%

A cricoid cartilage compression device for the accurate and reproducible application of cricoid pressure

et al. 2014

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SummaryWe describe the development and laboratory assessment of a refined prototype tactile feedback device for the safe and accurate application of cricoid pressure. We recruited 20 operating department practitioners and compared their performance of cricoid pressure on a training simulator using both the device and a manual unaided technique. The device significantly reduced the spread of the applied force: average (SE) root mean squared error decreased from 8.23 (0.48) N to 5.23 (0.32) N (p < 0.001). The average (SE) upwards bias in applied force also decreased, from 2.30 (0.74) N to 0.88 (0.48) N (p < 0.01). Most importantly, the percentage of force applications that deviated from target by more than 10 N decreased from 18% to 7% (p < 0.01). The device requires no prior training, is cheap to manufacture, is single-use and requires no power to operate, whilst ensuring that the correct force is always consistently applied.

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Regurgitation and oesophageal rupture with cricoid pressure: a cActaver study

Abstract: SummaryThe efficacy of cricoid pressure was studied in 10

Cited by 159 publications

References 13 publications

The effect of mechanically‐induced cricoid force on lower oesophageal sphincter pressure in anaesthetised patients

The effect of mechanically‐induced cricoid force on lower oesophageal sphincter pressure in anaesthetised patients

Airway obstruction with cricoid pressure

A cricoid cartilage compression device for the accurate and reproducible application of cricoid pressure

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