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Related Experiment Videos

Airway obstruction with cricoid pressure.

E L Hartsilver1, R G Vanner

  • 1Clinical Research Fellow and Specialist Registrar, Sir Humphry Davy Department of Anaesthesia, Bristol Royal Infirmary, Bristol BS2 8HW, UK.

Anaesthesia
|February 15, 2000
PubMed
Summary

Cricoid pressure can obstruct airways. Applying 30 N backwards is safer than upward-backward or 44 N, reducing airway obstruction risk during anesthesia.

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Area of Science:

  • Anesthesiology
  • Airway Management

Background:

  • Cricoid pressure is a common technique during anesthesia induction.
  • Potential for airway obstruction exists with cricoid pressure application.

Purpose of the Study:

  • To investigate the relationship between cricoid pressure force and application technique and airway obstruction.
  • To determine optimal cricoid pressure parameters to minimize airway obstruction risk.

Main Methods:

  • Ventilation was assessed in 52 female patients undergoing elective surgery.
  • Expired tidal volumes were measured under varying cricoid pressure conditions (0 N, 30 N backwards, 30 N upward-backward, 44 N backwards).
  • Airway obstruction was defined as expired tidal volume < 200 ml.

Main Results:

  • No airway obstruction occurred without cricoid pressure.
  • Airway obstruction occurred in 2% of patients with 30 N backwards pressure, 56% with 30 N upward-backward pressure, and 35% with 44 N backwards pressure.
  • A statistically significant difference (p=0.0001) was observed in obstruction rates based on force and direction.

Conclusions:

  • Cricoid pressure, particularly at higher forces (44 N) or with an upward-backward technique, increases the risk of airway obstruction.
  • Applying 30 N of backwards cricoid pressure appears to be a safer method, minimizing airway obstruction.
  • Careful consideration of force and direction is crucial for safe cricoid pressure application.

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