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The effect of mechanically-induced cricoid force on lower oesophageal sphincter pressure in anaesthetised patients

A Garrard1, A E Campbell, A Turley

  • 1Department of Anaesthetics and Intensive Care Medicine, University Hospital of Wales, Cardiff, UK.

Anaesthesia
|April 21, 2004
PubMed

Insights

Cricoid force, used in anesthesia, may increase regurgitation risk by reducing oesophageal barrier pressure (OBP) in patients. This study found that applying cricoid force significantly lowered OBP, potentially leading to gastroesophageal reflux.

Area of Science:

  • Anesthesiology
  • Gastroenterology
  • Critical Care Medicine

Background:

  • Cricoid force is a key technique for airway management during obstetric and emergency anesthesia in the UK.
  • Reduced oesophageal barrier pressure (OBP) is associated with an increased risk of regurgitation in anesthetized patients.

Purpose of the Study:

  • To investigate the effect of cricoid force on lower oesophageal sphincter pressure (LOSP) and OBP in anesthetized patients.
  • To determine if cricoid force application alters the pressure gradient protecting against gastroesophageal reflux.

Main Methods:

  • Twenty-nine patients undergoing anesthesia were studied.
  • An esophageal balloon catheter measured LOSP and gastric pressure before and during 30 N cricoid force application.
  • OBP was calculated as the difference between LOSP and gastric pressure.

Main Results:

  • Application of cricoid force significantly reduced OBP (p < 0.001).
  • Cricoid force did not significantly influence gastric pressure.
  • The reduction in OBP suggests a compromised barrier against reflux.

Conclusions:

  • The use of cricoid force in anesthetized patients may increase the risk of gastroesophageal reflux.
  • Anesthesiologists should consider the potential impact of cricoid force on oesophageal barrier function.

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