Application Of Cricoid Pressure Research Articles

Emergency airway management in patients with cervical spine injuries.

A retrospective study of admissions to a Level 1 Trauma Centre, revealed 393 patients with traumatic cervical spine injuries. All 36 patients intubated urgently and 37 and 68 patients intubated between 30 min and 24 h of admission, were intubated orally, following a rapid sequence induction with the application of cricoid pressure and manual in-line stabilisation of the head and neck. There were no neurological sequelae in these 73 patients (95% confidence interval 0-4%). This technique for airway management is described in detail. It is a safe, familiar, and effective method for securing the airway in patients with cervical spine injury.

Emergency intubation through the laryngeal mask airway The effective application of cricoid pressure

A patient with Kugelberg-Welander disease presented as an unexpected difficult intubation. Tracheal intubation was achieved through the laryngeal mask airway, while regurgitation was prevented with continuous cricoid pressure. Regurgitation occurred after cricoid pressure was released.

EFFECT OF CRICOID PRESSURE ON EASE OF INSERTION OF THE LARYNGEAL MASK AIRWAY

We have evaluated the effects of cricoid pressure on laryngeal mask airway (LMA) insertion after an elective rapid sequence induction in 100 patients allocated randomly to two groups. An attempt was made to insert the LMA after application of cricoid pressure in one group and with no pressure in the other. The anaesthetist was blinded to the application of cricoid pressure. Insertion was successful in 45 of 50 patients in the cricoid pressure group and in 49 of 50 patients in the non-cricoid group (P < 0.1) We discuss the implications of these findings for failed intubation in the nonfasted patient.

CRICOID PRESSURE MAY PREVENT INSERTION OF THE LARYNGEAL MASK AIRWAY

We have studied 42 female patients undergoing elective day-case surgery allocated randomly to two groups. After induction of anaesthesia an attempt was made to insert a laryngeal mask airway after application of cricoid pressure in one group or with no cricoid pressure in the other. The anaesthetist was unaware of the application, or not, of cricoid pressure. Successful insertion was achieved at the first or second attempt in 19 of the 22 patients in the non-cricoid pressure group, but in only three of the 20 patients in the cricoid pressure group (chi 2 18.62, P < 0.001). The laryngeal mask airway was then inserted successfully in all 17 patients after removal of cricoid pressure. The implications of having to remove cricoid pressure if a laryngeal mask airway is to be inserted are discussed.

Upper oesophageal sphincter pressure and the intravenous induction of anaesthesia

The upper oesophageal sphincter can prevent regurgitation of oesophageal contents into the pharynx following gastrooesophageal reflux in the awake patient. Upper oesophageal sphincter pressure was recorded with a Dent sleeve after hypnosis with midazolam (n = 7) and also during the rapid intravenous induction of anaesthesia with thiopentone (n = 16) or ketamine (n = 7). Thiopentone decreased mean (SD) sphincter pressure from an awake value of 43 (19) to 9 (7) mmHg (p less than 0.001) and midazolam from 38 (25) to 7 (3) mmHg (p less than 0.02). Mean (SD) sphincter pressures before and after ketamine were not significantly different at 29 (15) and 32 (21) mmHg respectively. After suxamethonium mean (SD) sphincter pressure in all patients (n = 30) was 7 (4) mmHg. Laryngoscopy (n = 30) caused a small increase in mean (SD) sphincter pressure to 13 (10) mmHg (p less than 0.001). Thiopentone caused a rapid fall in upper oesophageal sphincter pressure which usually started before loss of consciousness. These findings have implications for the timing of cricoid pressure application.

Upper oesophageal sphincter pressure and the effect of cricoid pressure.

Upper oesophageal sphincter pressure has been measured in 24 patients with a sleeve device. The median sphincter pressure when awake was 38 mmHg, and when anaesthetized and paralysed was 6 mmHg. After tracheal intubation, cricoid pressure was applied at measured values between 5 and 50 N using a hand-held cricoid yoke while the sphincter pressure was recorded in two head and neck positions: with and without a standard intubating pillow with neck support. A cricoid force of 40 N increased sphincter pressure to above 38 mmHg in all the patients and the use of the pillow did not alter this effect. With the application of cricoid pressure, operating department assistants raised sphincter pressure to above 38 mmHg in only 50% of patients. Laryngoscopy made little difference to the effect of cricoid pressure except in one patient in whom it reduced the sphincter pressure by 27 mmHg.

Rupture of the Oesophagus During Cricoid Pressure

Summary Rupture of the oesophagus occurred during the application of cricoid pressure at induction of anaesthesia when the patient vomited. The patient, who was bleeding from a gastric ulcer, was found to have a lower oesophageal tear which, although repaired at operation, resulted in a fatal mediastinitis.

Airway obstruction following application of cricoid pressure

The widely practiced rapid-sequence induction with application of cricoid pressure is designed to facilitate endotracheal intubation in patients considered to be at high risk of aspiration. We describe a case in which this maneuver was performed on a patient with an undiagnosed traumatic injury to the larynx. The resulting airway obstruction required emergency surgical intervention. The clinical presentation, diagnosis, and management of such injuries are discussed.

Intubation through the laryngeal mask

Unexpected difficulty with tracheal intubation contributes to anaesthetic mortality. The laryngeal mask can almost always be placed satisfactorily and its position should facilitate blind intubation. A 6-mm cuffed tube will pass through both adult sizes of the mask and this study tested the feasibility of intubation through the mask. The effect of the application of cricoid pressure on the technique was also investigated. Intubation via the laryngeal mask was attempted in 100 routine patients: of the first 50 (group 1, no cricoid pressure), 45 (90%) were successfully intubated. Maintenance of cricoid pressure throughout the manoeuvre (group 2) reduced the success rate significantly to 56% (p less than 0.05). Despite the possibility that cricoid pressure may have to be interrupted momentarily, the ease with which the technique can be learnt, and the immediate availability of the necessary apparatus suggest that it should be considered for inclusion in failed intubation drill.

Rupture of the oesophagus during cricoid pressure

Rupture of the oesophagus occurred during the application of cricoid pressure at induction of anaesthesia when the patient vomited. The patient, who was bleeding from a gastric ulcer, was found to have a lower oesophageal tear which, although repaired at operation, resulted in a fatal mediastinitis.

Bimanual cricoid pressure

AnaesthesiaVolume 45, Issue 12 p. 1091-1092 Free Access Bimanual cricoid pressure N. Koehli, N. Koehli Bristol Royal Infirmary, Bristol BS2 8HWSearch for more papers by this author N. Koehli, N. Koehli Bristol Royal Infirmary, Bristol BS2 8HWSearch for more papers by this author First published: December 1990 https://doi.org/10.1111/j.1365-2044.1990.tb14915.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. References 1 Latto IP., Rosen M. Difficulties in tracheal intubation, 1st edn. London : Bailliere Tindall, 1985. 2 Miller W. Anesthesia, Vol. 1, New York : Churchill Livingstone, 1986. 3 Wraight WJ., Chamney AR., Howells TH.. The determination of effective cricoid pressure. Anaesthesia 1983; 38: 461– 6. 4 Howells TH., Chamney AR., Wraight WJ., Simons RS.. The application of cricoid pressure. An assessment and a survey of its practice. Anaesthesia 1983; 38: 457– 60. Volume45, Issue12December 1990Pages 1091-1092 ReferencesRelatedInformation

Pharyngoesophageal intubation injuries: Three case reports

The hypopharynx and cervical esophagus are particularly vulnerable to intubation trauma. Contributing factors include hasty intubation by inexperienced personnel; the use of curved, beveled endotracheal tubes containing stylets; malpositioning of the head, and the application of cricoid pressure. latrogenic pharyngoesophageal perforations may go unsuspected until characteristic signs and symptoms are recognized. These include cervical pain, fever, dysphagia, leukocytosis, subcutaneous emphysema, and pneumomediastinum. We present three cases that illustrate important points in recognizing, evaluating, and treating pharyngoesophageal perforations. The third case presents a chronic cervical esophageal perforation with secondary pseudodiverticulum, requiring resection of the pseudodiverticulum and a primary sternocleidomastoid muscle flap repair of the cervical esophageal defect. To our knowledge, this technique has not previously been reported.

The Prevention of Gastric Inflation???A Neglected Benefit of Cricoid Pressure

Comment This report confirms the efficacy of the “Sellick” maneuver in minimizing gastric ia sufflation during mask ventilation. The fact dot laryngeal (specifically, cricoid) pressure can prevent gastric insufflation during positive presanR ventilation through the mouth was noted by Job Hunter in 1776 in his Proposals for the Recovery of People Apparently Drowned and reiterated ft Brian Sellick in 1961 in his description of til maneuver that currently bears his name. However, this application of cricoid pressure has it ceived little attention until recent years. The of recent Standards and Guidelines for CPR andtXX published by the American Heart Association in 1986 have revived the use of the maneuver for this purpose during resuscitation. The emerging popular practice among anesthesiologists of avoiding depolarizing muscle relaxants with the necessity for mask ventilation while awaiting the onset of nondepolarizing drug action before intubation has led practitioners to begin utilizing the maneuver during this time. An interesting follow-up to this report would be a study designed to determine whether properly applied cricoid pressure, in fact, does increase the frequency of “difficult” ventilation as the authors suggest. Charles W. Otto, M.D.

CRICOID PRESSURE WITH OR WITHOUT THE “CRICOID YOKE”

The performance of cricoid pressure was studied in three groups of medical personnel likely to be involved in its application using the cricoid yoke and a test rig. The instrument enabled individuals who had no previous experience in the application of cricoid pressure to achieve results as good as those obtained by experienced anaesthetic staff. Furthermore, the instrument improved the consistency of the applied force in all groups, particularly if cricoid pressure was required for sustained periods of 30 s or more.

The Application of Cricoid Pressure

The Application of Cricoid Pressure

The application of cricoid pressure. An assessment and a survey of its practice.

A simple test rig was developed to assess the force applied during the application of cricoid pressure. Anaesthetists and paramedical personnel familiar with Sellick's manoeuvre were tested yielding results which indicate an unacceptably wide variation in performance in each group. The mean force was 46.4 N but 47% failed to reach a force of 44 N. In addition a survey was undertaken of trained anaesthetic staff to identify the current status of the manoeuvre. Of those sampled 78% routinely employed Sellick's manoeuvre and over 70% had experienced a problem with its application which exposed the patient to the risk of regurgitation.

The application of cricoid pressure.

The application of cricoid pressure.