Cricoid pressure does not increase the rate of failed intubation by direct laryngoscopy in adults
ABSTRACT Cricoid pressure (CP) is applied during induction of anesthesia to prevent regurgitation of gastric content and pulmonary aspiration. However, it has been suggested that CP makes tracheal intubation more difficult. This double-blind randomized study evaluated the effect of CP on orotracheal intubation by direct laryngoscopy in adults.
Seven hundred adult patients undergoing general anesthesia for elective surgery were randomly assigned to have a standardized CP (n = 344) or a sham CP (n = 356) during laryngoscopy and intubation. After anesthesia induction and complete muscle relaxation, a 30-s period was allowed to complete intubation with a Macintosh No. 3 laryngoscope blade. The primary endpoint was the rate of failed intubation at 30 s. The secondary endpoints included the intubation time, the Cormack and Lehane grade of laryngoscopic view, and the Intubation Difficulty Scale score.
Groups were similar for demographic data and risk factors for difficult intubation. The rates of failed intubation at 30 s were comparable for the two groups: 15 of 344 (4.4%) and 13 of 356 (3.7%) in the CP and sham CP groups, respectively (P = 0.70). The grades of laryngoscopic view and the Intubation Difficulty Scale score were also comparable. Median intubation time was slightly longer in the CP group than in the sham CP group (11.3 and 10.4 s, respectively, P = 0.001).
CP applied by trained personnel does not increase the rate of failed intubation. Hence CP should not be avoided for fear of increasing the difficulty of intubation when its use is indicated.
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ABSTRACT: Since 1961, cricoid pressure also called Sellick's manoeuver, combined with rapid sequence induction, is considered as a main component of the prevention of gastric content inhalation in patient at risk. It has been recommended by national advisory bodies, despite the lack of any randomized trial, supported by individual observation and cadaver studies. Sellick maneuver has been accused of deforming the larynx, of worsening the Cormack and Lehane score and of increasing the difficulty of laryngoscopy. This is due to a lack of knowledge and experience in practicing. The pressure is commonly too high making intubation difficult, but when it is too weak it is ineffective. The pressure is also commonly applied on the thyroid cartilage, causing a distortion of the anatomic structures. Cricoid pressure should be about 10 N in conscious patients, increasing to 30 N after the loss of consciousness. The cricoids pressure technique is still recommended in patients with high risk of regurgitation and inhalation. Learning and training should be promoted on simulators, in combination with monitoring of the value of pressure. This may lead to more homogeneous practices and may clarify the controversy.Le Praticien en Anesthésie Réanimation 09/2014; DOI:10.1016/j.pratan.2014.06.010
Article: Cricoid pressure: Where do we stand?[Show abstract] [Hide abstract]
ABSTRACT: In 1961, Sellick popularized the technique of cricoid pressure (CP) to prevent regurgitation of gastric contents during anesthesia induction. In the last two decades, clinicians have begun to question the efficacy of CP and therefore the necessity of this maneuver. Some have suggested abandoning it on the grounds that this maneuver is unreliable in producing midline esophageal compression. Moreover, it has been found that application of CP makes tracheal intubation and mask ventilation difficult and induces relaxation of the lower esophageal sphincter. There have also been reports of regurgitation of gastric contents and aspiration despite CP. Further, its effectiveness has been demonstrated only in cadavers; therefore, its efficacy lacks scientific validation. These concerns with the use of CP in modern anesthesia practice have been briefly reviewed in this article.Journal of Anaesthesiology Clinical Pharmacology 03/2014; 30(1):3-6. DOI:10.4103/0970-9185.125683
Annales francaises d'anesthesie et de reanimation 01/2008; 27(1):41-5. · 0.84 Impact Factor