The cricoid cartilage and the esophagus are not aligned in close to half of adult patients

Smith, Kevin J.; Ladak, Shayne; Choi, Peter T. L.; Dobranowski, Julian

doi:10.1007/bf03017931

Cited by 73 publications

(44 citation statements)

References 17 publications

(12 reference statements)

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“…Previous studies 16,17 suggest that the esophagus is displaced laterally to the cricoid in 52% of individuals; however, the sample size was small in these studies, and the area of interest was restricted to the C6 level. In these studies, the degree of esophageal deviation from the cricoid was examined, while interventional pain specialists who perform SGB using anatomic landmarks or fluoroscopy for guidance will be more interested in knowing the extent of the anterior zone covered by the esophagus.…”

Section: Discussionmentioning

confidence: 90%

Evaluation of sonoanatomy relevant to performing stellate ganglion blocks using anterior and lateral simulated approaches: an observational study

Bhatia

Flamer

Peng

2012

Can J Anesth/J Can Anesth

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Purpose Stellate (cervicothoracic) ganglion block (SGB) can be associated with serious complications, such as esophageal and vascular injury. The objective of this study was to evaluate the potential for vascular and esophageal injury in healthy subjects by examining the sonoanatomy of the neck relevant to the SGB at the sixth (C6) and seventh (C7) cervical vertebral levels and determining the incidence of blood vessels and esophagi in the simulated path of needle insertion in the conventional and two different ultrasound-guided approaches used to perform a SGB. Methods Ultrasound scanning of the neck at the C6 and C7 cervical vertebral levels was performed in 100 adult subjects, and the following measurements were obtained: the degree of deviation of the esophagus relative to the larynx/trachea; the likelihood of encountering a vessel in the simulated path of needle insertion in the two different approaches to SGB; the incidence of the vertebral artery being situated outside the foramen transversarium at the C6 level; and the distance of the simulated path of needle insertion in the anterior and lateral approaches to SGB at the C6 level. Results The position of the esophagus was found to be variable but lateral to the airway in 50% and 74% of the subjects at C6 and C7, respectively. The esophagus covered more than half of the distance between the airway and the carotid artery in 14% and 44% of the subjects at the C6 and C7 levels, respectively. With the anterior approach, a major vessel was observed in up to 29% and 43% of patients at the C6 and C7 levels, respectively. The vertebral artery was outside the foramen transversarium in 7% of subjects at the C6 level. Conclusion Major blood vessels and the esophagus are in close proximity to needle pathways during the anterior approach to SGB performed with either anatomic landmarking or fluoroscopic guidance. An ultrasound-guided lateral approach at the C6 level may possibly confer a greater margin of safety for performing SGB. RésuméObjectif Le bloc du ganglion stellaire (cervicothoracique) (BGS) peut eˆtre associe´a`des complications graves, telles que des le´sions oesophagiennes et vasculaires. Les objectifs de l'e´tude e´taient les suivants : e´tudier l'e´cho-anatomie du cou pertinente pour le BGS au niveau des 6 e et 7 e verte`bres cervicales (C6 et C7) chez des patients en bonne sante´, e´valuer le risque de le´sion vasculaire et oesophagienne en enregistrant l'incidence des vaisseaux sanguins et de This study was conducted with written informed consent from the study subjects. This report describes an observational clinical study, and it adheres to the STROBE guidelines.

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Section: Discussionmentioning

confidence: 90%

Evaluation of sonoanatomy relevant to performing stellate ganglion blocks using anterior and lateral simulated approaches: an observational study

Bhatia

Flamer

Peng

2012

Can J Anesth/J Can Anesth

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“…The use of CP in RSI/I is an accepted standard of care in non-fasting patients and in those at risk of aspiration. The CP application is still widely practiced despite the studies that cite increasing concerns with regard to its safety and efficacy (24)(25)(26).…”

Section: Discussionmentioning

confidence: 99%

Clinical Evaluation of the Cricoid Pressure Effect on Bag Mask Ventilation, ProSeal Laryngeal Mask Airway Placement and Ventilation

Joshi¹,

Prakash

Mullick

et al. 2018

Turk J Anaesth Reanim

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Objective: Supraglottic airway devices can be life-saving in the 'cannot intubate, cannot oxygenate' situation. The cricoid pressure (CP) is considered critical in the prevention of aspiration. The aim of this self-controlled study was to evaluate the effect of CP on the bag mask ventilation (BMV), and the placement of and the ventilation through, the ProSeal laryngeal mask airway (LMA). Methods: In 60 adult patients undergoing elective surgery, after induction of anaesthesia, the effect of bimanual CP (≈30N) on BMV, ventilation through the ProSeal LMA, its anatomic position and airway seal pressures were evaluated. CP was released, the ProSeal LMA was reseated (appropriate position), the above assessments were repeated, and the effect of CP on the tidal volume (TV) and peak inspiratory pressure (PIP) was noted. Results: Out of 60 patients, the bag mask ventilation with CP was adequate in 25 (41.7%) patients compared to 59 (98.3%) patients without CP; p<0.001. The ventilation via the ProSeal LMA with CP was excellent, adequate and impossible in 0.0% (0), 49.2% (29) and 50.8% (30) patients, respectively, compared to 93.3% (56), 6.7% (4), 0% (0) patients, respectively, without CP; p<0.001. Releasing CP and advancing the ProSeal LMA to its appropriate position significantly improved the ventilation and anatomic position scores; both p<0.001. Airway seal pressures improved significantly without CP compared to with CP; p<0.001). With the ProSeal LMA in a proper position, the CP application resulted in a significant decrease in the mean expired TV (489.14±91.62 vs. 355.08±104.42 mL) with an increase in PIP (16.72±5.01 vs. 30.71±6.74 cmH2O); both p<0.001. Conclusion:The application of bimanual CP (≈30N) interferes with the bag mask ventilation and prevents both the correct placement and ventilation via the ProSeal LMA in adult patients. Keywords: Cricoid pressure, laryngeal mask airway, ProSeal, ventilation Amaç: Supraglottik havayolu cihazları entübe edilemeyen, oksijen verilemeyen durumlarda hayat kurtarıcı olabilirler. Krikoid bası-nın (KB) aspirasyonun önlenmesinde kritik öneme sahip olduğu düşünülmektedir. Bu öz-kontrollü çalışmanın amacı, KB'nin balon maske ventilasyon (BMV) ve ProSeal laringeal maske havayolu (LMA) yerleştirilmesi ve ventilasyonu üzerindeki etkisini değer-lendirmektir. Yöntemler: Bimanüel KB'nin (≈30N) BMV üzerindeki etkisi, ProSeal LMA ile ventilasyon, anatomik pozisyonu ve havayolu seal basınçları, elektif cerrahi geçiren 60 yetişkin hastada anestezi indüksiyonu sonrasında değerlendirildi. KB serbest bırakıldı, ProSeal LMA tekrar yerleştirildi (uygun pozisyon), yukarıda belirtilen değerlendirmeler tekrarlandı ve KB'nin tidal volüm (TV) ve tepe inspirasyon basıncı (PIP) üzerindeki etkisi kaydedildi. Bulgular: Altmış hastadan 25'inde (%41,7) KB ile balon maske ventilasyon, 59 (%98,3) hasta ile kıyaslandığında yeterliydi (p<0,001). KB olmadan uygulamaya maruz kalan sırasıyla %93,3 (56), %6,7 (4) ve %0 (0) hasta ile kıyaslandığında, KB ile ProSeal LMA yoluyla ventilasyon hastaların %0,0 (0), %49,2...

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“…This finding shows that there cannot be esophageal compression by cricoid pressure and ultimately questioned the efficacy of Sellick's maneuver. [13] On application of cricoid pressure esophagus gets compressed was the finding of cadaveric study by Fanning in 1970. [14] In 2009 under magnetic resonance imaging studies, Rice et al found that on application of cricoid pressure hypopharynx is compressed and not the esophagus.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Pulmonary Aspiration and Sellick ’ S Maneuver in Emergency Lap a Rotomies

Subhedar¹,

Shelke²,

Patel³

2015

jemds

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The cricoid cartilage and the esophagus are not aligned in close to half of adult patients

Abstract: P Pu ur rp po os se e: : To determine the frequency and degree of lateral displacement of the esophagus relative to the cricoid cartilage ("cricoid") using computed tomography (CT) images of normal necks.

Cited by 73 publications

References 17 publications

Evaluation of sonoanatomy relevant to performing stellate ganglion blocks using anterior and lateral simulated approaches: an observational study

Evaluation of sonoanatomy relevant to performing stellate ganglion blocks using anterior and lateral simulated approaches: an observational study

Clinical Evaluation of the Cricoid Pressure Effect on Bag Mask Ventilation, ProSeal Laryngeal Mask Airway Placement and Ventilation

Evaluation of Pulmonary Aspiration and Sellick ’ S Maneuver in Emergency Lap a Rotomies

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