Abstract
Accurate localisation of the cricoid cartilage is a key step in the successful application of cricoid pressure during rapid sequence induction. Poorly localised pressure is unlikely to confer any protective benefit to our patients and may have deleterious effects on laryngoscopy. We postulated that the use of ultrasound would greatly improve the accuracy of cricoid cartilage localisation prior to the application of cricoid pressure.
Highlights
The application of cricoid pressure during rapid sequence induction to protect against aspiration of regurgitated gastric content was first described by Sellick in
Compression of the hypopharynx between the cricoid cartilage ring and the cervical vertebral bodies and prevertebral musculature has since became an integral component of the induction of anaesthesia in patient groups thought to be at high risk of aspiration [2,3]
Conflicting evidence relating to the safety and effectiveness of the technique and its inherent potential to distort airway anatomy have been raised by a number of individuals with some abandoning the practice altogether despite possible legal ramificiations [4,5,6,7]
Summary
Accurate localisation of the cricoid cartilage is a key step in the successful application of cricoid pressure during rapid sequence induction. Application of pressure at alternative locations in the neck will not achieve the desired occlusion of the hypopharynx and will not prevent regurgitation of gastric content Should such applied pressure lead to distortion of airway anatomy to such an extent that intubation is made more difficult no protection has been conferred to the patient and additional difficulty is delivered to the anaesthetist in a situation that by its nature may be challenging and stressful [10,11]. Driven by a desire to increase patient safety, the aim of this two part study was firstly to determine the accuracy with which operating department assistants and anaesthetic nurses are able to identify the cricoid cartilage using landmark techniques.
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