Trainability of Cricoid Pressure Force Application: A Simulation-Based Study

Noll, Eric; Shodhan, Shivam; Varshney, Arnavi; Gallagher, Christopher J.; Diemunsch, Pierre; Florence, F. Barry; Romeiser, Jamie; Bennett‐Guerrero, Elliott

doi:10.1213/ane.0000000000003385

Cited by 9 publications

(5 citation statements)

References 35 publications

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“…Cricoid force when applied blind exceeded cricoid force applied with the use of biofeedback sensor by a mean of 6-8 Newtons. We feel that this difference is of clinical importance, most clinical studies evaluating cricoid pressure had used a difference of 5 Newtons as an acceptable window [20].…”

Section: Discussionmentioning

confidence: 99%

“…Notwithstanding, even with the knowledge of the cricoid force range, it may not be easy to conceptualize force in Newtons and then translate it into practice. Relying on experience in applying the correct force is not reliable as studies had showed no correlation between performance with work experience or profession, rather, strength and dexterity may play a more important role [20,21,24]. Lastly, the consequence of inappropriate application of cricoid pressure is detrimental.…”

Section: Discussionmentioning

confidence: 99%

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Sellick maneuver assisted real-time to achieve target force range in simulated environment—A prospective observational cross-sectional study on manikin

et al. 2020

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A force sensor system was developed to give real-time visual feedback on a range of force. In a prospective observational cross-section study, twenty-two anaesthesia nurses applied cricoid pressure at a target range of 30-40 Newtons for 60 seconds in three sequential steps on manikin: Group A (step 1 blinded, no sensor), Group B (step 2 blinded sensor), Group C (step 3 sensor feedback). A weighing scale was placed below the manikin. This procedure was repeated once again at least 1 week apart. The feedback system used 3 different colours to indicate the force range achieved as below target, achieve target, above target. Significantly higher proportion of target cricoid pressure was achieved with the use of sensor feedback in Group C; 85.9% (95%CI: 82.7%-88.7%) compared to when blinded from sensor in Group B; 31.3% (95%CI: 27.4-35.4%). Cricoid force achieved blind (Group B) exceeded force achieved with feedback (Group C) by a mean of 8.0 (95%CI: 5.9-10.2, p<0.0001) and 6.2 (95%CI:4.1-8.3, p< 0.0001) Newtons in round 1 and 2 respectively. Weighing scale read lower than corresponding force sensor by a mean of 8.4 Newtons (95% CI: 7.1-9.7, p<0.0001) in group B and 5.8 Newtons (95% CI: 4.5-7.1, p<0.0001) in Group C. Force sensor visual feedback system enabled application of reproducible target cricoid pressure with less variability and has potential value in clinical use. Using weighing scale to quantify and train cricoid pressure requires a review. Understanding the force applied is the first step to make cricoid pressure a safe procedure.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Sellick maneuver assisted real-time to achieve target force range in simulated environment—A prospective observational cross-sectional study on manikin

et al. 2020

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“…Moreover several important disadvantages of cricoid pressure were observed: a higher incidence of Cormack-Lehane grade 3-4, a more difficult mask ventilation, a more difficult laryngeal mask insertion, a decreased lower esophageal sphincter tone and a more frequent gag reflex and higher incidence of vomiting 43 . Additionally, teaching the right practice of cricoid pressure remains impossible: neither anesthesiologists nor nurses can be trained to apply a pressure of 10 + 5 N and 30 + 5 N in a training model 46 . Furthermore, in clinical practice, even with the feedback of real-time measurements, it is biomechanically impossible to achieve 30 N cricoid pressure during the counter force of laryngoscopy 47 .…”

Section: Cricoid Pressure During Rapid Sequence Inductionmentioning

confidence: 99%

General anesthesia for maternal surgery during pregnancy: dogmas, myths and evidence, a narrative review

Bleeser,

Van de Velde,

Rex

et al. 2024

Acta Anaest Belg

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Up to 1% of pregnant women require general anesthesia and maternal non-obstetric surgery during pregnancy, of which urgent abdominal procedures are most commonly indicated. This narrative review summarizes several dogmas and myths on the management of general anesthesia during pregnancy and the corresponding evidence. While historical studies found delayed gastric emptying during pregnancy, recent evidence concluded that gastric emptying remains nearly normal during the entire pregnancy until the onset of labor. To correctly estimate the aspiration risk, gastric ultrasound should be increasingly performed. Based on the available evidence, the application of cricoid pressure should be discouraged during rapid sequence induction of pregnant women. A cuffed endotracheal tube is traditionally recommended, but laryngeal masks have been used in > 9000 patients undergoing cesarean section without observation of aspiration. All material to manage a difficult airway should be available as difficult intubation remains an ongoing concern in obstetrics. Risk factors for difficult intubation are nonobstetric in nature. Due to the lack of evidence for hemodynamic management, it is not possible to make an evidence-based recommendation. We recommend to adhere to the expert opinion of maintaining maternal blood pressure close to the normal physiologic value by using (15°-)30° left lateral tilt position, intravenous fluids and noradrenaline or phenylephrine. Most recent clinical observational studies suggested to consider laparoscopic over open surgery as a standard treatment for abdominal surgery. While animal studies observed impaired fetal brain development after prenatal anesthesia exposure, this could not be confirmed by an observational clinical study.

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“…Da der Krikoiddruck im Alltag selten angewandt wird, ist es wichtig, die Anwendung zu trainieren, da sich so deutlich bessere Erfolgsraten abzeichnen [29].…”

Section: Pr a Xisunclassified

Einleitung des nicht nüchternen Patienten: Welche Techniken sind zu verwenden?

Knoth¹,

Weber²,

Croll³

et al. 2019

Anästhesiol Intensivmed Notfallmed Schmerzther

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ZusammenfassungDie Rapid Sequence Induction and Intubation (RSII) ist das Anästhesieverfahren der Wahl bei aspirationsgefährdeten Patienten, die sich einem operativen Eingriff in Allgemeinanästhesie unterziehen müssen. Die klassische RSII beschränkt sich auf wenige Behandlungsempfehlungen. Diesen liegen selten evidenzbasierte Erkenntnisse zugrunde. Neue Techniken (z. B. Videolaryngoskopie) sowie neue Diagnostika (z. B. Sonografie) erfordern eine Reevaluation der traditionell praktizierten Techniken. In diesem Artikel werden nichtpharmakologische Behandlungsstrategien der RSII behandelt und alte sowie neue Methoden zur Minimierung des Aspirationsrisikos kritisch diskutiert. Zu diesen gehören neben der Magensonde und der Magensonografie die Abläufe rund um die Narkoseeinleitung, wie Lagerung, Zwischenbeatmung, Relaxometrie sowie der Krikoid- bzw. linksparatracheale Druck. Innerklinisch müssen allen Teammitgliedern Behandlungsstandards für die RSII bekannt und die Abläufe etabliert und eingeübt sein. Ziel dieses Artikels ist es, Systematiken darzustellen, die eine Entscheidungsgrundlage für lokale Handlungsanweisungen bilden können.

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Trainability of Cricoid Pressure Force Application: A Simulation-Based Study

Abstract: At baseline, performance was poor at achieving target forces specified by national guidelines. Simulation-based training improved the success rate, but no participant achieved the predefined threshold for proficiency.

Cited by 9 publications

References 35 publications

Sellick maneuver assisted real-time to achieve target force range in simulated environment—A prospective observational cross-sectional study on manikin

Sellick maneuver assisted real-time to achieve target force range in simulated environment—A prospective observational cross-sectional study on manikin

General anesthesia for maternal surgery during pregnancy: dogmas, myths and evidence, a narrative review

Einleitung des nicht nüchternen Patienten: Welche Techniken sind zu verwenden?

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