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Airway obstruction with cricoid pressure.
1Clinical Research Fellow and Specialist Registrar, Sir Humphry Davy Department of Anaesthesia, Bristol Royal Infirmary, Bristol BS2 8HW, UK.
Anaesthesia
|February 15, 2000
Summary
Cricoid pressure can obstruct airways. Applying 30 N backwards is safer than upward-backward or 44 N, reducing airway obstruction risk during anesthesia.
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.