Canadian Journal of Anaesthesia

, Volume 44, Issue 4, pp 414–425 | Cite as

Cricoid pressure

  • Joseph R. Brimacombe
  • Alison M. Berry
Review Article

Abstract

Purpose

Although encoid pressure (CP) is a superficially simple and appropriate mechanical method to protect the patient from regurgitation and gastnc insufflation, in practice it is a complex manoeuvre which is difficult to perform optimally. The purpose of this review is to examine and evaluate studies on the application of (CP). It deals with anatomical and physiological considerations, techniques employed, safety and efficacy issues and the impact of CP on airway management with special mention of the laryngeal mask airway.

Source of material

Three medical databases (48 Hours, Medline, and Reference Manager Update) were searched for citations containing key words, subject headings and text entnes on CP to October 1996.

Principle Findings

There have been no studies proving that CP is beneficial, yet there is evidence that it is often ineffective and that it may increase the nsk of failed intubation and regurgitation. After evaluation of all available data, potential guidelines are suggested for optimal use of CP in routine and complex situations.

Conclusions

If CP is to remain standard practice dunng induction of anaesthesia, it must be shown to be safe and effective. Meanwhile, further understanding of its advantages and limitations, improved training in its use, and guidelines on optimal force and method of application should lead to better patient care.

Keywords

Airway Management Laryngeal Mask Airway Cricoid Cartilage Cricoid Pressure Rapid Sequence Induction 

Résumé

Objectif

Bien qu’elle sort une méthode mécanique en apparence simple et appropnée exécutée pour protéger contre la régurgitation et l’insufflation gastrique, la compression du cricoïde (CC), en pratique, constitue une manoeuvre complexe et difficile à réaliser parfaitement. Cette revue vise l’analyse et l’évaluation des études publiées sur son usage. Elle porte sur les considérations anatomiques et physiologiques, les techniques utilisées, les problèmes de sécunté et d’efficacité et l’impact de la CC sur la gestion des voies aériennes avec une attention spéciale envers le masque laryngé.

Source

Trois bases de données médicales (48 Hours, Medline etReference Manager Update) ont été scrutées au regard des citations contenant les mots clés, les titres des sujets et les entrées de texte concernant la CC jusqu’au mois d’octobre 1996.

Principales constatations

Aucune étude n’a prouvé les bienfaits de la CC, alors qu’il est démontré qu’elle est souvent inefficace et qu’elle peut augmenter l’incidence des intubations échouées et des régurgitations. Après une évaluation de toutes les données disponibles, des lignes de conduites sont suggérées en vue d’une pratique optimale de la CC dans les situations courantes et complexes.

Conclusions

Si la CC dort demeurer une manoeuvre standard pendant l’induction de l’anesthésie, il faut faire la preuve qu’elle est sûre et efficace. En attendant, une meilleure compréhension de ses avantages et de ses limitations, un enseignement amélioré et des données plus précises sur la pression exercée idéale et son mode d’utilisation devraient nous aider à fournir de meilleurs soins.

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Copyright information

© Canadian Anesthesiologists 1997

Authors and Affiliations

  • Joseph R. Brimacombe
    • 1
  • Alison M. Berry
    • 1
  1. 1.Department of Anaesthesia and Intensive CareUniversity of Queensland, Cairns Base HospitalCairnsAustralia

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