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Cricoid pressure: can protective force be sustained?

T Meek1, A Vincent, J E Duggan

  • 1Northern School of Anaesthesia, Royal Victoria Infirmary, Newcastle-upon-Tyne.

British Journal of Anaesthesia
|August 6, 1998
PubMed
Summary
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Using an extended arm position for cricoid pressure significantly delays pain and fatigue compared to a flexed position. This finding is crucial for improving patient safety during difficult intubations.

Area of Science:

  • Anesthesiology
  • Emergency Medicine
  • Medical Simulation

Background:

  • Cricoid pressure is a critical maneuver during rapid sequence intubation to prevent aspiration.
  • Maintaining adequate cricoid pressure can be challenging and lead to operator fatigue and pain.

Purpose of the Study:

  • To compare the effects of arm position (flexed vs. extended) on the ability to maintain simulated cricoid pressure.
  • To assess the onset of pain and time to fatigue during sustained cricoid pressure application.

Main Methods:

  • Six operating department assistants performed simulated cricoid pressure on a laryngeal model.
  • Participants applied forces of 20, 30, and 40 Newtons (N) for a target of 20 minutes.
  • Arm position was either flexed at 90 degrees or fully extended.

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Main Results:

  • The extended arm position consistently resulted in longer times to pain onset and release due to fatigue across all tested forces.
  • None of the subjects could sustain 40 N for 20 minutes; the extended arm allowed longer application times.
  • More subjects achieved the target time at 20 N with the extended arm compared to the flexed arm.

Conclusions:

  • An extended arm position is superior for maintaining cricoid pressure, delaying pain and fatigue.
  • These findings have direct implications for optimizing techniques during emergency airway management.
  • Proper positioning can enhance the effectiveness and sustainability of cricoid pressure application.