Der Anaesthesist

, Volume 58, Issue 7, pp 695–707 | Cite as

Krikoiddruck

Notfallmedizin

Zusammenfassung

Die überwiegende Mehrheit aller Anästhesisten hält die Anwendung von Krikoiddruck aus Gründen der Patientensicherheit für einen unabdingbaren Bestandteil einer jeden Anästhesieschnelleinleitung. Krikoiddruck wird unter der Vorstellung angewendet, dadurch die Regurgitation von in den Ösophagus gelangtem Mageninhalt in den Pharynx mit anschließender pulmonaler Aspiration zu verhindern. Diese Übersichtsarbeit schildert den Hintergrund der Einführung des Krikoiddrucks in die klinische Praxis, analysiert die publizierten Daten hinsichtlich der klinischen Relevanz der perioperativen pulmonalen Aspiration und der Effektivität des Krikoiddrucks, diese zu verhindern, diskutiert Probleme bei dessen Ausübung, bewertet Kenntnisstand und technische Ausübung des Krikoiddrucks und präsentiert diverse aktuelle Empfehlungen zu dessen Anwendung. Vor dem Hintergrund gänzlich fehlender Evidenz für die Effektivität des Krikoiddrucks zur Prävention der pulmonalen Aspiration bei gleichzeitigem Vorliegen zahlreicher Berichte über eine teilweise klinisch relevante Beeinträchtigung des Atemwegsmanagements während dessen Ausübung muss die Empfehlung für die generelle Anwendung von Krikoiddruck während einer Schnelleinleitung ernsthaft infrage gestellt werden.

Schlüsselwörter

Krikoiddruck Schnelleinleitung Aspiration Perioperativ Pulmonal 

Cricoid pressure

Abstract

The vast majority of anaesthetists considers application of cricoid pressure for reasons of patient safety an integral part of rapid sequence induction. Cricoid pressure is applied with the idea that it will prevent regurgitation of gastric content into the pharynx, thereby reducing the incidence of pulmonary aspiration. This review describes the background of the introduction of cricoid pressure into clinical practice, analyzes published data concerning clinical relevance of perioperative pulmonary aspiration and efficacy of cricoid pressure in reducing it, discusses problems associated with its use, assesses knowledge and technical performance of cricoid pressure and presents various recent recommendations regarding application of cricoid pressure. The combination of complete lack of evidence for the efficacy of cricoid pressure in preventing pulmonary aspiration and numerous reports of clinically relevant interference with airway management during its use, seriously question the rationale of recommending the general use of cricoid pressure during rapid sequence induction.

Keywords

Cricoid pressure Rapid sequence induction Aspiration Perioperative Pulmonary 

Literatur

  1. 1.
    Ahtaridis G, Snape WJ Jr, Cohen S (1981) Lower esophageal sphincter pressure as an index of gastroesophageal acid reflux. Dig Dis Sci 26:993–998PubMedCrossRefGoogle Scholar
  2. 2.
    Allman KG (1995) The effect of cricoid pressure application on airway patency. J Clin Anesth 7:197–199PubMedCrossRefGoogle Scholar
  3. 3.
    Ansermino JM, Blogg CE (1992) Cricoid pressure may prevent insertion of the laryngeal mask airway. Br J Anaesth 69:465–467PubMedCrossRefGoogle Scholar
  4. 4.
    Aoyama K, Takenaka I, Sata T et al (1996) Cricoid pressure impedes positioning and ventilation through the laryngeal mask airway. Can J Anaesth 43:1035–1040PubMedCrossRefGoogle Scholar
  5. 5.
    Asai T, Barclay K, Power I et al (1995) Cricoid pressure impedes placement of the laryngeal mask airway. Br J Anaesth 74:521–525PubMedCrossRefGoogle Scholar
  6. 6.
    Asai T, Goy RW, Liu EH (2007) Cricoid pressure prevents placement of the laryngeal tube and laryngeal tube-suction II. Br J Anaesth 99:282–285PubMedCrossRefGoogle Scholar
  7. 7.
    Benumof JL (1994) Difficult laryngoscopy: obtaining the best view. Can J Anaesth 41:361–365PubMedCrossRefGoogle Scholar
  8. 8.
    Benumof JL, Cooper SD (1996) Quantitative improvement in laryngoscopic view by optimal external laryngeal manipulation. J Clin Anesth 8:136–140PubMedCrossRefGoogle Scholar
  9. 9.
    Birnbach DJ, Browne IM (2005) Anesthesia for obstetrics. In: Miller RD (ed) Miller’s anesthesia. Elsevier, London, pp 2307–2344Google Scholar
  10. 10.
    Borland LM, Sereika SM, Woelfel SK et al (1998) Pulmonary aspiration in pediatric patients during general anesthesia: incidence and outcome. J Clin Anesth 10:95–102PubMedCrossRefGoogle Scholar
  11. 11.
    Brimacombe J, Berry A (1997) Cricoid pressure in chaos. Anaesthesia 52:924–926PubMedGoogle Scholar
  12. 12.
    Brimacombe J, White A, Berry A (1993) Effect of cricoid pressure on ease of insertion of the laryngeal mask airway. Br J Anaesth 71:800–802PubMedCrossRefGoogle Scholar
  13. 13.
    Brimacombe JR, Berry AM (1997) Cricoid pressure. Can J Anaesth 44:414–425PubMedCrossRefGoogle Scholar
  14. 14.
    Brock-Utne JG (2002) Is cricoid pressure necessary? Paediatr Anaesth 12:1–4PubMedCrossRefGoogle Scholar
  15. 15.
    Butler J, Sen A (2005) Best evidence topic report. Cricoid pressure in emergency rapid sequence induction. Emerg Med J 22:815–816PubMedCrossRefGoogle Scholar
  16. 16.
    Caplan RA, Posner KL, Ward RJ et al (1990) Adverse respiratory events in anesthesia: a closed claims analysis. Anesthesiology 72:828–833PubMedCrossRefGoogle Scholar
  17. 17.
    Cheney FW, Posner KL, Caplan RA (1991) Adverse respiratory events infrequently leading to malpractice suits. A closed claims analysis. Anesthesiology 75:932–939PubMedCrossRefGoogle Scholar
  18. 18.
    Clark RK, Trethewy CE (2005) Assessment of cricoid pressure application by emergency department staff. Emerg Med Australas 17:376–381PubMedCrossRefGoogle Scholar
  19. 19.
    Clayton TJ, Vanner RG (2002) A novel method of measuring cricoid force. Anaesthesia 57:326–329PubMedCrossRefGoogle Scholar
  20. 20.
    Cook TM (1996) Cricoid pressure: are two hands better than one? Anaesthesia 51:365–368PubMedCrossRefGoogle Scholar
  21. 21.
    Cook TM, Godfrey I, Rockett M et al (2000) Cricoid pressure: which hand? Anaesthesia 55:648–653PubMedCrossRefGoogle Scholar
  22. 22.
    Cormack RS, Lehane J (1984) Difficult tracheal intubation in obstetrics. Anaesthesia 39:1105–1111PubMedCrossRefGoogle Scholar
  23. 23.
    Cowling J (1982) Cricoid pressure – A more comfortable technique. Anaesth Intensive Care 10:93–94PubMedGoogle Scholar
  24. 24.
    Crowley DS, Giesecke AH (1990) Bimanual cricoid pressure. Anaesthesia 45:588–589PubMedCrossRefGoogle Scholar
  25. 25.
    Cullen W (1776) A letter to Lord Cathcart concerning the recovery of persons drowned and seemingly dead. Gedruckt für J Murray. Fleet-Street, LondonGoogle Scholar
  26. 26.
    Ellis DY, Harris T, Zideman D (2007) Cricoid pressure in emergency department rapid sequence tracheal intubations: a risk-benefit analysis. Ann Emerg Med 50:653–665PubMedCrossRefGoogle Scholar
  27. 27.
    Fanning GL (1970) The efficacy of cricoid pressure in preventing regurgitation of gastric contents. Anesthesiology 32:553–555PubMedCrossRefGoogle Scholar
  28. 28.
    Flick RP, Schears GJ, Warner MA (2002) Aspiration in pediatric anesthesia: is there a higher incidence compared with adults? Curr Opin Anaesthesiol 15:323–327PubMedCrossRefGoogle Scholar
  29. 29.
    Flucker CJ, Hart E, Weisz M et al (2000) The 50-millilitre syringe as an inexpensive training aid in the application of cricoid pressure. Eur J Anaesthesiol 17:443–447PubMedGoogle Scholar
  30. 30.
    Garrard A, Campbell AE, Turley A et al (2004) The effect of mechanically-induced cricoid force on lower oesophageal sphincter pressure in anaesthetised patients. Anaesthesia 59:435–439PubMedCrossRefGoogle Scholar
  31. 31.
    Georgescu A, Miller JN, Lecklitner ML (1992) The Sellick maneuver causing complete airway obstruction. Anesth Analg 74:457–459PubMedCrossRefGoogle Scholar
  32. 32.
    Gogarten W, Marcus MA, Van Aken H (2001) Gynäkologie und Geburtshilfe. In: Kochs E, Krier C, Buzello W, Adams HA (Hrsg) Anästhesiologie. Thieme, Stuttgart, pp 1008–1023Google Scholar
  33. 33.
    Haddad JK (1970) Relation of gastroesophageal reflux to yield sphincter pressures. Gastroenterology 58:175–184PubMedGoogle Scholar
  34. 34.
    Hartsilver EL, Vanner RG (2000) Airway obstruction with cricoid pressure. Anaesthesia 55:208–211PubMedCrossRefGoogle Scholar
  35. 35.
    Haslam N, Duggan JE (2004) Cricoid pressure. Anaesthesia 59:91–92CrossRefGoogle Scholar
  36. 36.
    Haslam N, Parker L, Duggan JE (2005) Effect of cricoid pressure on the view at laryngoscopy. Anaesthesia 60:41–47PubMedCrossRefGoogle Scholar
  37. 37.
    Hawkins JL, Koonin LM, Palmer SK et al (1997) Anesthesia-related deaths during obstetric delivery in the United States, 1979–1990. Anesthesiology 86:277–284PubMedCrossRefGoogle Scholar
  38. 38.
    Hawthorne L, Wilson R, Lyons G et al (1996) Failed intubation revisited: 17-yr experience in a teaching maternity unit. Br J Anaesth 76:680–684PubMedGoogle Scholar
  39. 39.
    Heath KJ, Palmer M, Fletcher SJ (1996) Fracture of the cricoid cartilage after Sellick’s manoeuvre. Br J Anaesth 76:877–878PubMedGoogle Scholar
  40. 40.
    Henderson JJ, Popat MT, Latto IP et al (2004) Difficult Airway Society guidelines for management of the unanticipated difficult intubation. Anaesthesia 59:675–694PubMedCrossRefGoogle Scholar
  41. 41.
    Herman NL, Carter B, Van Decar TK (1996) Cricoid pressure: teaching the recommended level. Anesth Analg 83:859–863PubMedCrossRefGoogle Scholar
  42. 42.
    Ho AM, Wong W, Ling E et al (2001) Airway difficulties caused by improperly applied cricoid pressure. J Emerg Med 20:29–31PubMedCrossRefGoogle Scholar
  43. 43.
    Hocking G, Roberts FL, Thew ME (2001) Airway obstruction with cricoid pressure and lateral tilt. Anaesthesia 56:825–828PubMedCrossRefGoogle Scholar
  44. 44.
    Holloway RH, Hongo M, Berger K et al (1985) Gastric distention: a mechanism for postprandial gastroesophageal reflux. Gastroenterology 89:779–784PubMedGoogle Scholar
  45. 45.
    Howells TH, Chamney AR, Wraight WJ et al (1983) The application of cricoid pressure. An assessment and a survey of its practice. Anaesthesia 38:457–460PubMedGoogle Scholar
  46. 46.
    Hunter J (1776) Of persons apparently drowned. Philos Trans 46:171Google Scholar
  47. 47.
    Jackson SH (1996) Efficacy and safety of cricoid pressure needs scientific validation. Anesthesiology 84:751–752PubMedCrossRefGoogle Scholar
  48. 48.
    Jöhr M (2007) Anaesthesia for the child with a full stomach. Curr Opin Anaesthesiol 20:201–203PubMedCrossRefGoogle Scholar
  49. 49.
    Knill RL (1993) Difficult laryngoscopy made easy with a „BURP“. Can J Anaesth 40:279–282PubMedCrossRefGoogle Scholar
  50. 50.
    Kopka A, Crawford J (2004) Cricoid pressure: a simple, yet effective biofeedback trainer. Eur J Anaesthesiol 21:443–447PubMedGoogle Scholar
  51. 51.
    Koziol CA, Cuddeford JD, Moos DD (2000) Assessing the force generated with application of cricoid pressure. AORN J 72:1018–1028PubMedCrossRefGoogle Scholar
  52. 52.
    Kron SS (1995) Questionable effectiveness of cricoid pressure in preventing aspiration. Anesthesiology 83:431PubMedCrossRefGoogle Scholar
  53. 53.
    La Cour D (1970) Prevention of rise in intragastric pressure due to suxamethonium fasciculations by prior dose of d-tubocurarine. Acta Anaesthesiol Scand 14:5–15Google Scholar
  54. 54.
    Landsman I (2004) Cricoid pressure: indications and complications. Paediatr Anaesth 14:43–47PubMedCrossRefGoogle Scholar
  55. 55.
    Lawes EG, Campbell I, Mercer D (1987) Inflation pressure, gastric insufflation and rapid sequence induction. Br J Anaesth 59:315–318PubMedCrossRefGoogle Scholar
  56. 56.
    Lawes EG, Duncan PW, Bland B et al (1986) The cricoid yoke – A device for providing consistent and reproducible cricoid pressure. Br J Anaesth 58:925–931PubMedCrossRefGoogle Scholar
  57. 57.
    Levy DM (2006) Traditional rapid sequence induction is an outmoded technique for caesarean section and should be modified. Proposed. Int J Obstet Anesth 15:227–229PubMedCrossRefGoogle Scholar
  58. 58.
    Li CW, Xue FS, Xu YC et al (2007) Cricoid pressure impedes insertion of and ventilation through the ProSeal laryngeal mask airway in anesthetized, paralyzed patients. Anesth Analg 104:1195–1198PubMedCrossRefGoogle Scholar
  59. 59.
    Lind JF, Smith AM, McIver DK et al (1968) Heartburn in pregnancy – A manometric study. Can Med Assoc J 98:571–574PubMedGoogle Scholar
  60. 60.
    MacG Palmer JH, Ball DR (2000) The effect of cricoid pressure on the cricoid cartilage and vocal cords: an endoscopic study in anaesthetised patients. Anaesthesia 55:263–268CrossRefGoogle Scholar
  61. 61.
    May P, Trethewy C (2007) Practice makes perfect? Evaluation of cricoid pressure task training for use within the algorithm for rapid sequence induction in critical care. Emerg Med Australas 19:207–212PubMedCrossRefGoogle Scholar
  62. 62.
    McNelis U, Syndercombe A, Harper I et al (2007) The effect of cricoid pressure on intubation facilitated by the gum elastic bougie. Anaesthesia 62:456–459PubMedCrossRefGoogle Scholar
  63. 63.
    Meek T (2006) Traditional rapid sequence induction is an outmoded technique for Caesarean section and should be modified. Opposed. Int J Obstet Anesth 15:229–232PubMedCrossRefGoogle Scholar
  64. 64.
    Meek T, Gittins N, Duggan JE (1999) Cricoid pressure: knowledge and performance amongst anaesthetic assistants. Anaesthesia 54:59–62PubMedCrossRefGoogle Scholar
  65. 65.
    Mellin-Olsen J, Fasting S, Gisvold SE (1996) Routine preoperative gastric emptying is seldom indicated. A study of 85,594 anaesthetics with special focus on aspiration pneumonia. Acta Anaesthesiol Scand 40:1184–1188PubMedGoogle Scholar
  66. 66.
    Mendelson CL (1946) The aspiration of stomach content into the lungs during obstetric anesthesia. Am J Obstet Gynecol 52:191–205Google Scholar
  67. 67.
    Mittal RK, Chiareli C, Liu J et al (1996) Characteristics of lower esophageal sphincter relaxation induced by pharyngeal stimulation with minute amounts of water. Gastroenterology 111:378–384PubMedCrossRefGoogle Scholar
  68. 68.
    Mittal RK, Stewart WR, Schirmer BD (1992) Effect of a catheter in the pharynx on the frequency of transient lower esophageal sphincter relaxations. Gastroenterology 103:1236–1240PubMedGoogle Scholar
  69. 69.
    Morgan M (1986) The confidential enquiry into maternal deaths. Anaesthesia 41:689–691PubMedCrossRefGoogle Scholar
  70. 70.
    Morris J, Cook TM (2001) Rapid sequence induction: a national survey of practice. Anaesthesia 56:1090–1097PubMedCrossRefGoogle Scholar
  71. 71.
    Neelakanta G (2003) Cricoid pressure is effective in preventing esophageal regurgitation. Anesthesiology 99:242PubMedCrossRefGoogle Scholar
  72. 72.
    Neilipovitz DT, Crosby ET (2007) No evidence for decreased incidence of aspiration after rapid sequence induction. Can J Anaesth 54:748–764PubMedCrossRefGoogle Scholar
  73. 73.
    Olsson GL, Hallen B, Hambraeus-Jonzon K (1986) Aspiration during anaesthesia: a computer-aided study of 185,358 anaesthetics. Acta Anaesthesiol Scand 30:84–92PubMedCrossRefGoogle Scholar
  74. 74.
    Owen H, Follows V, Reynolds KJ et al (2002) Learning to apply effective cricoid pressure using a part task trainer. Anaesthesia 57:1098–1101PubMedCrossRefGoogle Scholar
  75. 75.
    Patten SP (2006) Educating nurses about correct application of cricoid pressure. AORN J 84:449–461PubMedCrossRefGoogle Scholar
  76. 76.
    Priebe HJ (2005) Cricoid pressure: an evidence-based practice? Middle East J Anesthesiol 18:485–492PubMedGoogle Scholar
  77. 77.
    Quigley P, Jeffrey P (2007) Cricoid pressure: assessment of performance and effect of training in emergency department staff. Emerg Med Australas 19:218–222PubMedCrossRefGoogle Scholar
  78. 78.
    Rabey PG, Murphy PJ, Langton JA et al (1992) Effect of the laryngeal mask airway on lower oesophageal sphincter pressure in patients during general anaesthesia. Br J Anaesth 69:346–348PubMedCrossRefGoogle Scholar
  79. 79.
    Ralph SJ, Wareham CA (1991) Rupture of the oesophagus during cricoid pressure. Anaesthesia 46:40–41PubMedCrossRefGoogle Scholar
  80. 80.
    Rattan S, Goyal RK (1974) Neural control of the lower esophageal sphincter: influence of the vagus nerves. J Clin Invest 54:899–906PubMedCrossRefGoogle Scholar
  81. 81.
    Rosen M (1981) Anesthesia for obstetrics. Anaesthesia 36:145–146PubMedCrossRefGoogle Scholar
  82. 82.
    Sakai T, Planinsic RM, Quinlan JJ et al (2006) The incidence and outcome of perioperative pulmonary aspiration in a university hospital: a 4-year retrospective analysis. Anesth Analg 103:941–947PubMedCrossRefGoogle Scholar
  83. 83.
    Salem MR, Bruninga KW, Dodlapatii J et al (2008) Metoclopramide does not attenuate cricoid pressure-induced relaxation of the lower esophageal sphincter in awake volunteers. Anesthesiology 109:806–810PubMedCrossRefGoogle Scholar
  84. 84.
    Salem MR, Joseph NJ, Heyman HJ et al (1985) Cricoid compression is effective in obliterating the esophageal lumen in the presence of a nasogastric tube. Anesthesiology 63:443–446PubMedCrossRefGoogle Scholar
  85. 85.
    Salem MR, Sellick BA, Elam JO (1974) The historical background of cricoid pressure in anesthesia and resuscitation. Anesth Analg 53:230–232PubMedGoogle Scholar
  86. 86.
    Salem MR, Wong AY, Fizzotti GF (1972) Efficacy of cricoid pressure in preventing aspiration of gastric contents in paediatric patients. Br J Anaesth 44:401–404PubMedCrossRefGoogle Scholar
  87. 87.
    Salem MR, Wong AY, Mani M et al (1974) Efficacy of cricoid pressure in preventing gastric inflation during bag-mask ventilation in pediatric patients. Anesthesiology 40:96–98PubMedCrossRefGoogle Scholar
  88. 88.
    Samsoon GL, Young JR (1987) Difficult tracheal intubation: a retrospective study. Anaesthesia 42:487–490PubMedCrossRefGoogle Scholar
  89. 89.
    Schmidt A, Akeson J (2001) Practice and knowledge of cricoid pressure in southern Sweden. Acta Anaesthesiol Scand 45:1210–1214PubMedCrossRefGoogle Scholar
  90. 90.
    Schmidt J, Strauß JM, Becke K et al (2007) Handlungsempfehlung zur Rapid-Sequence-Induction im Kindesalter. Anaesthesiol Intensivmed 48:S88–S93Google Scholar
  91. 91.
    Schwartz DE, Cohen NH (1995) Questionable effectiveness of cricoid pressure in preventing aspiration. Anesthesiology 83:432CrossRefGoogle Scholar
  92. 92.
    Schwartz DE, Matthay MA, Cohen NH (1995) Death and other complications of emergency airway management in critically ill adults. A prospective investigation of 297 tracheal intubations. Anesthesiology 82:367–376PubMedCrossRefGoogle Scholar
  93. 93.
    Sellick BA (1961) Cricoid pressure to control regurgitation of stomach contents during induction of anaesthesia. Lancet 2:404–406PubMedCrossRefGoogle Scholar
  94. 94.
    Shorten GD, Alfille PH, Gliklich RE (1991) Airway obstruction following application of cricoid pressure. J Clin Anesth 3:403–405PubMedCrossRefGoogle Scholar
  95. 95.
    Smith KJ, Dobranowski J, Yip G et al (2003) Cricoid pressure displaces the esophagus: an observational study using magnetic resonance imaging. Anesthesiology 99:60–64PubMedCrossRefGoogle Scholar
  96. 96.
    Smith KJ, Ladak S, Choi PT et al (2002) The cricoid cartilage and the esophagus are not aligned in close to half of adult patients. Can J Anaesth 49:503–507PubMedCrossRefGoogle Scholar
  97. 97.
    Snider DD, Clarke D, Finucane BT (2005) The „BURP“ maneuver worsens the glottic view when applied in combination with cricoid pressure. Can J Anaesth 52:100–104PubMedCrossRefGoogle Scholar
  98. 98.
    Stept WJ, Safar P (1970) Rapid induction-intubation for prevention of gastric-content aspiration. Anesth Analg 49:633–636PubMedCrossRefGoogle Scholar
  99. 99.
    Thorn K, Thorn SE, Wattwil M (2005) The effects of cricoid pressure, remifentanil and propofol on esophageal motility and the lower esophageal sphincter. Anesth Analg 100:1200–1203PubMedCrossRefGoogle Scholar
  100. 100.
    Tiret L, Desmonts JM, Hatton F et al (1986) Complications associated with anaesthesia – A prospective survey in France. Can Anaesth Soc J 33:336–344PubMedCrossRefGoogle Scholar
  101. 101.
    Tiret L, Nivoche Y, Hatton F et al (1988) Complications related to anaesthesia in infants and children. A prospective survey of 40,240 anaesthetics. Br J Anaesth 61:263–269PubMedCrossRefGoogle Scholar
  102. 102.
    Tournadre JP, Chassard D, Berrada KR et al (1997) Cricoid cartilage pressure decreases lower esophageal sphincter tone. Anesthesiology 86:7–9PubMedCrossRefGoogle Scholar
  103. 103.
    Turgeon AF, Nicole PC, Trepanier CA et al (2005) Cricoid pressure does not increase the rate of failed intubation by direct laryngoscopy in adults. Anesthesiology 102:315–319PubMedCrossRefGoogle Scholar
  104. 104.
    Vanner RG (2001) Techniques of cricoid pressure. Anaesth Intensive Care Med 2:362–363Google Scholar
  105. 105.
    Vanner RG (1992) Tolerance of cricoid pressure by conscious volunteers. Int J Obstet Anesth 1:195–198PubMedCrossRefGoogle Scholar
  106. 106.
    Vanner RG, Asai T (1999) Safe use of cricoid pressure. Anaesthesia 54:1–3PubMedCrossRefGoogle Scholar
  107. 107.
    Vanner RG, Clarke P, Moore WJ et al (1997) The effect of cricoid pressure and neck support on the view at laryngoscopy. Anaesthesia 52:896–900PubMedCrossRefGoogle Scholar
  108. 108.
    Vanner RG, O’Dwyer JP, Pryle BJ et al (1992) Upper oesophageal sphincter pressure and the effect of cricoid pressure. Anaesthesia 47:95–100PubMedCrossRefGoogle Scholar
  109. 109.
    Vanner RG, Pryle BJ (1993) Nasogastric tubes and cricoid pressure. Anaesthesia 48:1112–1113PubMedCrossRefGoogle Scholar
  110. 110.
    Vanner RG, Pryle BJ (1992) Regurgitation and oesophageal rupture with cricoid pressure: a cadaver study. Anaesthesia 47:732–735PubMedCrossRefGoogle Scholar
  111. 111.
    Veall GR, Swinhoe CF (1994) A good reason to employ ambidextrous ODAs? Anaesthesia 49:556–557PubMedCrossRefGoogle Scholar
  112. 112.
    Warner MA, Warner ME, Warner DO et al (1999) Perioperative pulmonary aspiration in infants and children. Anesthesiology 90:66–71PubMedCrossRefGoogle Scholar
  113. 113.
    Warner MA, Warner ME, Weber JG (1993) Clinical significance of pulmonary aspiration during the perioperative period. Anesthesiology 78:56–62PubMedCrossRefGoogle Scholar
  114. 114.
    Weiss M, Gerber AC (2007) Anasthesieeinleitung und Intubation beim Kind mit vollem Magen. Zeit zum Umdenken! Anaesthesist 56:1210–1216PubMedCrossRefGoogle Scholar
  115. 115.
    Whittington RM, Robinson JS, Thompson JM (1979) Fatal aspiration (Mendelson’s) syndrome despite antacids and cricoid pressure. Lancet 314:228–230CrossRefGoogle Scholar
  116. 116.
    Williamson R (1991) Bimanual cricoid pressure – Another version. Anaesthesia 46:510PubMedCrossRefGoogle Scholar
  117. 117.
    Wraight WJ, Chamney AR, Howells TH (1983) The determination of an effective cricoid pressure. Anaesthesia 38:461–466PubMedGoogle Scholar
  118. 118.
    Yentis SM (1997) The effects of single-handed and bimanual cricoid pressure on the view at laryngoscopy. Anaesthesia 52:332–335PubMedCrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag 2009

Authors and Affiliations

  1. 1.Anästhesiologische Universitätsklinik FreiburgFreiburgDeutschland

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