Comment on ‘A survey of self-reported use of cricoid pressure amongst Australian and New Zealand anaesthetists: Attitudes and practice’

Compelling Evidence for Effectiveness of Cricoid Pressure in Occluding the Esophageal Entrance: Where Do We Go From Here?

“…4–6 The difficulties encountered with some trainees, the progressive loss of the cricoid force with time, the complications associated with inadequate or excessive force, and the desire to modify the force in certain situations (morbid obesity, women, and children) are all valid reasons why the cricoid force should be measured and not estimated. 3–6 Devices used in recent studies possess most of the features desired in an ideal device to measure the exact cricoid force. 1,4–6…”

“…3–6 Devices used in recent studies possess most of the features desired in an ideal device to measure the exact cricoid force. 1,4–6…”

“…1,6 Indeed, the successful use of the RSI technique is contingent on proper application of CP and attention to other variables that contribute to regurgitation and aspiration. 1,6…”

“…Although intensive training using technologyenhanced simulation can markedly improve proper application of the CP maneuver, 1 we believe the time has come for clinicians and researchers to rely on devices to obtain accurate measurement of the cricoid force. [4][5][6] The difficulties encountered with some trainees, the progressive loss of the cricoid force with time, the complications associated with inadequate or excessive force, and the desire to modify the force in certain situations (morbid obesity, women, and children) are all valid reasons why the cricoid force should be measured and not estimated. [3][4][5][6] Devices used in recent studies possess most of the features desired in an ideal device to measure the exact cricoid force.…”

“…[4][5][6] The difficulties encountered with some trainees, the progressive loss of the cricoid force with time, the complications associated with inadequate or excessive force, and the desire to modify the force in certain situations (morbid obesity, women, and children) are all valid reasons why the cricoid force should be measured and not estimated. [3][4][5][6] Devices used in recent studies possess most of the features desired in an ideal device to measure the exact cricoid force. 1,[4][5][6] Although aspiration of gastric contents can occur as a result of improperly applied CP, it can also occur before the application and after the release of correctly applied CP due to faulty techniques, 1,6 including failure to place a nasogastric tube before anesthetic induction when indicated, incomplete muscular relaxation, airway obstruction, excessive positive pressure ventilation, and premature endotracheal extubation.…”