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Krikoiddruck

Cricoid pressure

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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.

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.

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  1. Anästhesiologische Universitätsklinik Freiburg, Hugstetter Str. 55, 79106, Freiburg, Deutschland

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Steinmann, D., Priebe, HJ. Krikoiddruck. Anaesthesist 58, 695–707 (2009). https://doi.org/10.1007/s00101-009-1548-6

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