Cricoid force: time to put it to one side.

Naik, Keyur; Frerk, C.

doi:10.1111/anae.14470

Cited by 7 publications

(5 citation statements)

References 24 publications

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“…Any cervical compression can have deleterious effects on carotid blood flow, and the impact of LPP in this context has been questioned in an editorial. 19 First, a direct compression on the carotid artery may reduce the diameter or occlude the vessel. Depending on the patency of the circle of Willis, there may be a risk of transient ischemia.…”

Section: Introductionmentioning

confidence: 99%

Effect of left paratracheal pressure on left carotid blood flow

Javillier,

Grandjean,

Ounas

et al. 2023

Acta Anaesthesiol Scand

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IntroductionGautier et al. demonstrated that a compression in the left paratracheal region (left paratracheal pressure, LPP) can be used to seal the oesophagus. However, at this level, the left common carotid artery is very close to the carotid that could be affected during the manipulation. This study aimed to assess the hemodynamic effects of LPP on the carotid blood flow.MethodsWe prospectively included 47 healthy adult volunteers. We excluded pregnant women and people with anomalies of the carotid arteries. The common and internal carotid arteries were preliminarily studied with ultrasounds to exclude atheromatous plaques or vascular malformation. A planimetry of the common and internal carotid arteries was performed. Doppler echography served to measure the peak systolic (PSV) and end‐diastolic velocities (EDV) in the common and internal carotid arteries. All measurements were repeated while applying LPP.ResultsForty‐seven participants were enrolled (32 women; mean [SD] age: 42 [13] years).The mean PSV difference [95% CI] in the left common carotid artery before and after LPP at the group level was −15.30 [−31.09 to 0.48] cm s−1 (p = .14). The mean surface difference [95% CI] in the left common carotid artery before and after LPP was 24.52 [6.11–42.92] mm2 (p = .11). Similarly, the same surface at the level of the left internal carotid artery changed by −18.89 [−51.59 to 13.80] mm2 after LPP (p = .58).ConclusionsOur results suggest that LPP does not have a significant effect on carotid blood flow in individuals without a carotid pathology. However, the safety of the manoeuvre should be evaluated in patients at risk of carotid anomalies.

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Section: Introductionmentioning

confidence: 99%

Effect of left paratracheal pressure on left carotid blood flow

Javillier,

Grandjean,

Ounas

et al. 2023

Acta Anaesthesiol Scand

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“…Further efficacy and safety studies are required to determine whether paratracheal pressure is effective in preventing gastric reflux or aspiration, and whether any adverse effects are not greater compared to cricoid pressure. 24 Similar to cricoid pressure, paratracheal pressure may deteriorate the laryngoscopic view because the maneuver is applied to an adjacent region of the airway. Therefore, we tested the hypothesis that paratracheal pressure would not deteriorate the glottic view during direct laryngoscopy, compared to cricoid pressure.…”

mentioning

confidence: 99%

Effect of Paratracheal Pressure on the Glottic View During Direct Laryngoscopy: A Randomized Double-Blind, Noninferiority Trial

Won

Kim

Chang

et al. 2021

Anesthesia &Amp; Analgesia

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BACKGROUND: Cricoid pressure has been used as a component of the rapid sequence induction and intubation technique. However, concerns have been raised regarding the effectiveness and safety of cricoid pressure. Paratracheal pressure, a potential alternative to cricoid pressure to prevent regurgitation of gastric contents or aspiration, has been studied to be more effective to cricoid pressure in preventing gastric insufflation during positive pressure ventilation. However, to adopt paratracheal compression into our practice, adverse effects including its effect on the glottic view during direct laryngoscopy should be studied. We conducted a randomized, double-blind, noninferiority trial comparing paratracheal and cricoid pressures for any adverse effects on the view during direct laryngoscopy, together with other secondary outcome measures. METHODS: In total, 140 adult patients undergoing general anesthesia randomly received paratracheal pressure (paratracheal group) or cricoid pressure (cricoid group) during anesthesia induction. The primary end point was the incidence of deteriorated laryngoscopic view, evaluated by modified Cormack–Lehane grade with a predefined noninferiority margin of 15%. Secondary end points included percentage of glottic opening score, ease of mask ventilation, change in ventilation volume and peak inspiratory pressure during mechanical mask ventilation, ease of tracheal intubation, and resistance encountered while advancing the tube into the glottis. The position of the esophagus was assessed by ultrasound in both groups to determine whether pressure applied to the respective area would be likely to result in esophageal compression. All secondary outcomes were tested for superiority, except percentage of glottic opening score, which was tested for noninferiority. RESULTS: Paratracheal pressure was noninferior to cricoid pressure regarding the incidence of deterioration of modified Cormack–Lehane grade (0% vs 2.9%; absolute risk difference, −2.9%; 95% confidence interval, −9.9 to 2.6, P <.0001). Mask ventilation, measured on an ordinal scale, was found to be easier (ie, more likely to have a lower score) with paratracheal pressure than with cricoid pressure (OR, 0.41; 95% confidence interval, 0.21–0.79; P = .008). The increase in peak inspiratory pressure was significantly less in the paratracheal group than in the cricoid group during mechanical mask ventilation (median [min, max], 0 [−1, 1] vs 0 [−1, 23]; P = .001). The differences in other secondary outcomes were nonsignificant between the groups. The anatomical position of the esophagus was more suitable for compression in the paratracheal region, compared to the cricoid cartilage region. CONCLUSIONS: Paratracheal pressure was noninferior to cricoid pressure with respect to the effect on glottic view during direct laryngoscopy.

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“…This is because the oesophagus deviates from the midline towards the left in its descent, making it more visible and accessible for compression distally at the paratracheal level[18]. Although further studies are required to evaluate the effectiveness of paratracheal force for occluding the oesophagus, it may compress the oesophagus effectively without adversely affecting airway management[19].…”

mentioning

confidence: 99%

The effect of cricoid and paralaryngeal force on upper oesophageal occlusion during induction of anaesthesia: a randomised, crossover study

et al. 2019

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Summary The aim of this study was to evaluate the effectiveness of cricoid and paralaryngeal force for oesophageal entrance occlusion during induction of anaesthesia. Seventy‐four patients were included in this randomised, crossover study. The relative position of the glottis and outer anteroposterior diameter of the upper oesophageal entrance were assessed at baseline, after the application of 30 N cricoid and paralaryngeal force, and after induction of anaesthesia. The occlusion rate of the oesophageal entrance with cricoid and paralaryngeal force was assessed during direct laryngoscopy. The relative position of the upper oesophageal entrance to the glottis changed in 45 out of 74 patients after induction of anaesthesia and during direct laryngoscopy compared with the awake state. The application of cricoid and paralaryngeal force decreased the mean (SD) diameter of the upper oesophageal entrance to a similar degree in awake (8.5 (2.1) mm to 6.4 (1.7) mm and 6.5 (1.6) mm, respectively; p < 0.001) and anaesthetised (8.7 (2.2) mm to 6.5 (1.7) mm and (6.7 (1.9) mm, respectively; p < 0.001) states. During direct laryngoscopy, the occlusion rate of the oesophageal entrance was greater with cricoid compared with paralaryngeal force (46/74 vs. 26/74, respectively; p = 0.002). The relative position of the upper oesophageal entrance to the glottis may change after induction of anaesthesia and during direct laryngoscopy. Cricoid and paralaryngeal force both decrease the diameter of the upper oesophageal entrance in awake and anaesthetised states. Occlusion of the oesophageal entrance is achieved more frequently with cricoid force compared with paralaryngeal force during direct laryngoscopy.

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Cricoid force: time to put it to one side.

Cited by 7 publications

References 24 publications

Effect of left paratracheal pressure on left carotid blood flow

Effect of left paratracheal pressure on left carotid blood flow

Effect of Paratracheal Pressure on the Glottic View During Direct Laryngoscopy: A Randomized Double-Blind, Noninferiority Trial

The effect of cricoid and paralaryngeal force on upper oesophageal occlusion during induction of anaesthesia: a randomised, crossover study

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