Cricoid pressure: Where do we stand?

Area of Science:

• Anesthesiology
• Patient Safety
• Airway Management

Background:

• Cricoid pressure (CP) is a maneuver used during anesthesia induction to prevent gastric regurgitation.
• Concerns regarding the efficacy and safety of CP have emerged in recent decades.
• The necessity of CP in modern anesthesia practice is increasingly debated.

Purpose of the Study:

• To review the concerns and controversies surrounding the use of cricoid pressure in anesthesia.
• To evaluate the scientific evidence supporting the effectiveness of CP.
• To discuss the implications of these concerns for current anesthetic practices.

Main Methods:

• Literature review of studies and reports on cricoid pressure.
• Analysis of clinical observations and cadaver studies.
• Discussion of the physiological effects of cricoid pressure.

Main Results:

• CP's efficacy in achieving midline esophageal compression is questioned.
• CP can impede tracheal intubation and mask ventilation.
• CP may induce lower esophageal sphincter relaxation, potentially increasing regurgitation risk.
• Reports exist of aspiration occurring despite CP application.
• Evidence for CP's effectiveness is primarily from cadaver studies, lacking validation in live patients.

Conclusions:

• The routine use of cricoid pressure in anesthesia is being re-evaluated due to significant concerns about its efficacy and safety.
• The scientific basis for CP's effectiveness is limited, with potential adverse effects on airway management and esophageal integrity.
• Further research and clinical evaluation are needed to determine the appropriate role of CP in modern anesthesia.