Rupture of the oesophagus following cricoid pressure?

Abstract

Correspondence 2 13been given TDP needed an intramuscular injection of dihydrocodeine in the recovery ward.Children have been shown to prefer the oral route for premedication.2 We had hoped that by using TDP, which was first described by D i c k~o n ,~ who used a slightly different dosage regimen, we might discover some improvement in comparison with trimeprazine alone by increasing the anti-emetic effect with the addition of droperidol and producing analgesia with methadone (Physeptone).The effectiveness of premedication in children is strongly influenced by their pre-operative surroundings. The children in our unit are supervised in a playroom until they become drowsy; they are then allowed to sleep in a darkened room adjacent to the anaesthetic room. This is a most satisfactory arrangement and it is rare that a crying or frightened child arrives for induction of anaesthesia. The authors felt that the TDP mixture was the superior premedicant despite the double-blind nature of the trial and that its use might result in more obvious advantages in units without these facilities. Department of Anaesthesia, CATHERINE BULLEN Pain after the injection of methohexitoneAnaesthetists continue to be concerned about the high incidence of pain on injection of some intravenous agents, and this has sometimes been alleviated by changing the solvent. The leaflet provided by Eli Lilly and Co. Lid., the manufactorers of 'Brietal' Sodium (methohexitone), states that 'pain at the site of injection and a burning sensation along the course of the vein have occasionally been reported', and a major textbook advises that, although methohexitone may cause pain, this is not remembered afterwards and is therefore of no significance.' These statements certainly underestimate the incidence and severity of the pain, and Rowlandsz has shown that some patients do remember the pain afterwards, sometimes vividly. Methohexitone can be dissolved in normal saline; although such a solution is only stable for 24 hours. In 100 successive unpremedicated patients over the age of 12 years, methohexitone was administered dissolved in water (SO) or saline (SO). None of the patients had received methohexitone previously and none of them was warned that there might be any noticeable sideeffects. All the injections were made through a 21-gauge Butterfly needle (Abbott) in the dorsum of the hand, using steady pressure via a 21-gauge needle through the rubber cap. Spontaneous expressions of pain, wincing or withdrawal of the injected hand were recorded.Twenty-one patients who received the aqueous solution complained of pain (42%) whilst in the saIine group only eight (16%) of the injections provoked pain. The 42% incidence was unexpectedly high, and is unacceptable even allowing for the fact that the patients were not premedicated. Recent work has shown reductions in the incidence of pain on injection of methohexitone (64%) by pretreatment with lignocaine 10 mg (22%);3 perhaps this overall incidence could be further reduced by adding lignocaine to 'Brietal' Sod...

Rapid sequence induction: a questionnaire survey of its routine conduct and continued management during a failed intubation

“…However, even moderate cricoid pressure may cause pain, coughing or vomiting [16]. In 1982, Sellick suggested that cricoid pressure should be applied simultaneously with the loss of consciousness and the onset of muscle relaxation [21]. This ideal may be almost impossible to achieve in practice, however.…”

Effect of raised lung volume technique on subsequent measures of V′maxFRC in infants

“…However, while it may reduce the occurrence, 28 there is currently no proven evidence that cricoid pressure prevents gastric distension from occurring during these maneuvers. Furthermore, for effective occlusion of air entry through the esophagus, very firm pressure on the trachea is required, such that Sellick 29 and Brock-Utne 30 recommended that cricoid pressure only be applied once the patient has lost consciousness (i.e., shortly after induction of anesthesia). Effective application of cricoid pressure in lightly sedated infants may therefore prove disturbing and painful and would cause an early termination to any study protocol.…”

Hyperergic Aspiration Pneumonitis (Mendelson Syndrome)

“…Однако приме нение давления на перстневидный хрящ перед вводным наркозом может оказаться болезненным, неприятным и, таким образом, провоцирующим неконтролируемые кашель и рвотные позывы, об струкцию дыхательных путей, регургитацию и рвоту. Впоследствии он же рекомендовал приме нять давление на перстневидный хрящ, когда па циент уже без сознания [23]. Было обнаружено, что без давления на перстневидный хрящ меток лопрамид значительно увеличивал предельное давление во время ручной вентиляции, тогда как атропин существенно снижал его [24].…”