Cricoid pressure: An enigma wrapped in a mystery or a hand wrapped around a throat? If I can′t disprove a lie, does it become the truth?

Background:Peroral endoscopic myotomy (POEM) is a novel method of treating achalasia of the esophagus. Very little data are available to guide the anesthesia providers caring for these patients. The anesthetic challenges are primarily related to the risk of pulmonary aspiration. There is also a potential risk of pneumomediastinum, pneumoperitoneum, subcutaneous, or submucosal emphysema, as a result of carbon dioxide tracking into the soft tissues surrounding the esophagus and lower esophageal sphincter.Methods:In this retrospective study, electronic charts of 24 patients who underwent POEM over 18 months were reviewed. Demographic data, fasting status, relevant aspiration risks, anesthetic technique, and postoperative care measures were extracted.Results:Fasting times for both solids and liquids were variable. None of the patients underwent preprocedural esophageal emptying. Standard induction and intubation were performed in 16, rapid sequence induction (RSI) with cricoid pressure in seven, and modified rapid sequence without application of cricoid pressure in one of the patients. One of the patients aspirated at induction, and the procedure was aborted. However, the procedure was performed successfully after a few weeks, this time a RSI with cricoid pressure was chosen.Conclusion:As there are no guidelines for the perioperative management of patients presenting for POEM presently, certain recommendations can be made. Preprocedural esophageal emptying should be considered in patients considered as high-risk, although cultural factors might preclude such an approach. Induction and intubation in a semi-reclining position might be useful. Although debatable, use of RSI with cricoid pressure should be strongly considered.

show abstract

“…Recent skepticism surrounding the use of RSI with cricoid pressure might have played a part in this decision. [ 7 8 ]…”

Section: Discussionmentioning

confidence: 99%

Peroral endoscopic myotomy—initial experience with anesthetic management of 24 procedures and systematic review

2016

Self Cite

View full text Add to dashboard Cite

show abstract

Cricoid pressure: An enigma wrapped in a mystery or a hand wrapped around a throat? If I can′t disprove a lie, does it become the truth?

Cited by 1 publication

References 5 publications

Peroral endoscopic myotomy—initial experience with anesthetic management of 24 procedures and systematic review

Peroral endoscopic myotomy—initial experience with anesthetic management of 24 procedures and systematic review

Contact Info

Product

Resources

About