Practice and knowledge of cricoid pressure in southern Sweden

For 40 years cricoid pressure has been used to prevent regurgitation of gastric contents during induction of anaesthesia. Recent studies have emphasised use of more moderate force so as not to deteriorate ventilation or endotracheal intubation. This study was undertaken to assess the current practice and knowledge of cricoid pressure among anaesthesia personnel in southern Sweden.

Forty-eight subjects at two anaesthetic departments in southern Sweden were asked to apply and maintain cricoid pressure for 60 s with their dominant and non-dominant hands, respectively, in a laryngotracheal model during simulated intravenous induction of anaesthesia. Where and how pressure was applied as well as the force used by each subject was recorded together with information on individual experience and knowledge of the technique.

There were no significant changes in force applied over time, and no significant differences in force between dominant (median 36 N; 25th percentile 26 N; 75th percentile 50 N) and non-dominant (37; 26; 50 N) hand, between female and male subjects or between physicians, nurses and assistant nurses. Force exceeding 60 N was recorded at least once in 21% of subjects. More than two-thirds (69%) had not heard of any recommended level of force to be applied. Forty percent of anaesthesiologists were unaware of any contraindications.

More specific education and training seems mandatory to improve clinical use of cricoid pressure and possibly increase patient safety. Simulators allowing cricoid pressure to be carried out and evaluated in a standardised manner should therefore be incorporated into future training programmes and airway management courses.