Quantifying the Effective Cricoid Force to Occlude the Esophageal Entrance in Anesthetized and Muscle-Relaxed...

Area of Science:

• Pediatric Anesthesiology
• Airway Management
• Clinical Measurement

Background:

• Cricoid pressure use in pediatric anesthesia lacks defined force parameters, raising safety and efficacy concerns.
• Hypothesized that excessive cricoid force may contribute to airway complications during pediatric procedures.

Purpose of the Study:

• To measure and define the median cricoid force required to occlude the esophagus during videolaryngoscopy in children.
• To assess the safety and effectiveness of age-appropriate cricoid force application in pediatric airway management.

Main Methods:

• Employed a novel instrument to measure cricoid force in 120 anesthetized children (3-14 years) undergoing Glidescope® videolaryngoscopy.
• Utilized a biased-coin up-and-down design to determine the force needed to prevent esophageal suction catheter insertion.
• Categorized children into three age groups: 3-5, 6-8, and 9-14 years.

Main Results:

• No difficult endotracheal intubations were recorded.
• Median cricoid forces to prevent esophageal catheter insertion were 4.85 N (3-5 yrs), 8.74 N (6-8 yrs), and 13.0 N (9-14 yrs).
• Measured forces were significantly lower than thresholds for airway distortion and adult recommendations.

Conclusions:

• Age-appropriate cricoid force, guided by videolaryngoscopy, effectively seals the esophagus without impeding endotracheal intubation in children.
• These findings suggest safer application of cricoid pressure for rapid sequence intubation (RSI) in pediatric patients at risk of aspiration.
• The study provides crucial data for refining cricoid pressure techniques in pediatric anesthesia.