The application of cricoid pressure.

Howells, T. H.; Chamney, Anne R.; Wraight, W. J.; Simons, R.

doi:10.1111/j.1365-2044.1983.tb12077.x

Cited by 13 publications

(4 citation statements)

References 3 publications

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“…3 On the other hand, cases of gastric regurgitation have been introduced even though cricoid pressure was applied. 4,5 More than 20 N of cricoid pressure is uncomfortable and can induce retching, which can lead to pulmonary aspiration. 6 The recommended cricoid pressure is 10 N in awake patients and 30 N in unconscious patients.…”

mentioning

confidence: 99%

Effectiveness of Cricoid and Paratracheal Pressures in Occluding the Upper Esophagus Through Induction of Anesthesia and Videolaryngoscopy: A Randomized, Crossover Study

Kim

Chang

Won

et al. 2022

Anesthesia &Amp; Analgesia

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BACKGROUND: Maneuvers for preventing passive regurgitation of gastric contents are applied to effectively occlude the esophagus throughout rapid sequence induction and intubation. The aim of this randomized, crossover study was to investigate the effectiveness of cricoid and paratracheal pressures in occluding the esophagus through induction of anesthesia and videolaryngoscopy. METHODS: After the induction of anesthesia in 40 adult patients, the location of the esophageal entrance relative to the glottis and location of the upper esophagus relative to the trachea at the low paratracheal region were assessed using an ultrasonography, and the outer diameter of the esophagus was measured on ultrasound before and during application of cricoid and paratracheal pressures of 30 N. Then, videolaryngoscopy was performed with the application of each pressure. During videolaryngoscopy, location of the esophageal entrance relative to the glottis under cricoid pressure was examined on the screen of videolaryngoscope, and the upper esophagus under paratracheal pressure was evaluated using ultrasound. The occlusion rate of the esophagus, and the best laryngeal view using the percentage of glottic opening scoring system were also assessed during videolaryngsocopy. Esophageal occlusion under each pressure was determined by inserting an esophageal stethoscope into the esophagus. If the esophageal stethoscope could not be advanced into the esophagus under the application of each pressure, the esophagus was regarded to be occluded. RESULTS: During videolaryngoscopy, esophagus was occluded in 40 of 40 (100%) patients with cricoid pressure and 23 of 40 (58%) patients with paratracheal pressure (difference, 42%; 95% confidence interval, 26–58; P < .001). Both cricoid and paratracheal pressures significantly decreased the diameter of the esophagus compared to no intervention in the anesthetized paralyzed state (P < .001, respectively). Ultrasound revealed that the compressed esophagus by paratracheal pressure in the anesthetized paralyzed state was partially released during videolaryngoscopy in 17 of 40 patients, in whom esophageal occlusion was unsuccessful. The best laryngeal view was not significantly different among the no intervention, cricoid pressure, and paratracheal pressure (77 [29] % vs 79 [30] % vs 76 [31] %, respectively; P = .064). CONCLUSIONS: The occlusion of the upper esophagus defined by inability to pass an esophageal stethoscope was more effective with cricoid pressure than with paratracheal pressure during videolaryngoscopy, although both cricoid and paratracheal pressures reduced the diameter of the esophagus on ultrasound in an anesthetized paralyzed state.

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confidence: 99%

Effectiveness of Cricoid and Paratracheal Pressures in Occluding the Upper Esophagus Through Induction of Anesthesia and Videolaryngoscopy: A Randomized, Crossover Study

Kim

Chang

Won

et al. 2022

Anesthesia &Amp; Analgesia

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“…The conventional teaching has been that the patient should not be ventilated manually to avoid gastric inflation. 64 Gastric inflation was found to be unlikely if the peak airway pressure is less than 20 cmH 2 O in patients who are not paralysed and in the absence of cricoid pressure. 65 When the patient is paralysed gastric inflation may occur at a lower peak airway pressure.…”

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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“…12,13 Indeed, there have been reports of aspiration of gastric contents, regardless of cricoid pressure application. 14,15 Also, cricoid pressure can interfere with tracheal intubation by worsening the glottic view during direct laryngoscopy. 16,17 In a recent large randomized controlled trial, cricoid pressure caused longer intubation time and worsened Cormack-Lehane grade during direct laryngoscopy compared to a sham procedure, suggesting an increased difficulty in tracheal intubation by cricoid pressure.…”

mentioning

confidence: 99%

“…12,13 Indeed, there have been reports of aspiration of gastric contents, regardless of cricoid pressure application. 14,15…”

mentioning

confidence: 99%

Effect of Paratracheal Pressure on the Glottic View During Direct Laryngoscopy: A Randomized Double-Blind, Noninferiority Trial

Won

Kim

Chang

et al. 2021

Anesthesia &Amp; Analgesia

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BACKGROUND: Cricoid pressure has been used as a component of the rapid sequence induction and intubation technique. However, concerns have been raised regarding the effectiveness and safety of cricoid pressure. Paratracheal pressure, a potential alternative to cricoid pressure to prevent regurgitation of gastric contents or aspiration, has been studied to be more effective to cricoid pressure in preventing gastric insufflation during positive pressure ventilation. However, to adopt paratracheal compression into our practice, adverse effects including its effect on the glottic view during direct laryngoscopy should be studied. We conducted a randomized, double-blind, noninferiority trial comparing paratracheal and cricoid pressures for any adverse effects on the view during direct laryngoscopy, together with other secondary outcome measures. METHODS: In total, 140 adult patients undergoing general anesthesia randomly received paratracheal pressure (paratracheal group) or cricoid pressure (cricoid group) during anesthesia induction. The primary end point was the incidence of deteriorated laryngoscopic view, evaluated by modified Cormack–Lehane grade with a predefined noninferiority margin of 15%. Secondary end points included percentage of glottic opening score, ease of mask ventilation, change in ventilation volume and peak inspiratory pressure during mechanical mask ventilation, ease of tracheal intubation, and resistance encountered while advancing the tube into the glottis. The position of the esophagus was assessed by ultrasound in both groups to determine whether pressure applied to the respective area would be likely to result in esophageal compression. All secondary outcomes were tested for superiority, except percentage of glottic opening score, which was tested for noninferiority. RESULTS: Paratracheal pressure was noninferior to cricoid pressure regarding the incidence of deterioration of modified Cormack–Lehane grade (0% vs 2.9%; absolute risk difference, −2.9%; 95% confidence interval, −9.9 to 2.6, P <.0001). Mask ventilation, measured on an ordinal scale, was found to be easier (ie, more likely to have a lower score) with paratracheal pressure than with cricoid pressure (OR, 0.41; 95% confidence interval, 0.21–0.79; P = .008). The increase in peak inspiratory pressure was significantly less in the paratracheal group than in the cricoid group during mechanical mask ventilation (median [min, max], 0 [−1, 1] vs 0 [−1, 23]; P = .001). The differences in other secondary outcomes were nonsignificant between the groups. The anatomical position of the esophagus was more suitable for compression in the paratracheal region, compared to the cricoid cartilage region. CONCLUSIONS: Paratracheal pressure was noninferior to cricoid pressure with respect to the effect on glottic view during direct laryngoscopy.

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The application of cricoid pressure.

Cited by 13 publications

References 3 publications

Effectiveness of Cricoid and Paratracheal Pressures in Occluding the Upper Esophagus Through Induction of Anesthesia and Videolaryngoscopy: A Randomized, Crossover Study

Effectiveness of Cricoid and Paratracheal Pressures in Occluding the Upper Esophagus Through Induction of Anesthesia and Videolaryngoscopy: A Randomized, Crossover Study

Rapid Sequence Induction and Intubation

Effect of Paratracheal Pressure on the Glottic View During Direct Laryngoscopy: A Randomized Double-Blind, Noninferiority Trial

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