The Cricoid Force Necessary to Occlude the Esophageal Entrance: Is There a Gender Difference?

Abstract

(Anesth Analg. 2017;124(4):1168–1173) Cricoid force (CF) is used to occlude the esophageal lumen and prevent regurgitation during surgery. However, excessive CF can deform the cricoid cartilage, oppose the vocal cords, interfere with tracheal tube passage, and result in ineffective gas exchange. Due to differences in cricoid plate size, women may require less CF than is recommended in the literature (at least 44 N). The authors of the present study hypothesized that gender differences exist in the necessary CF application to prevent regurgitation. Using a Glidescope video laryngoscope in anesthetized and paralyzed patients, they assessed the effectiveness of different CFs in occluding the esophageal entrance in men and women.

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…”

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

“…6 The progressive loss of force with prolonged application, the complications associated with excessive or inadequate force and the need to modify the force in women and morbidly obese patients, are all valid reasons why the cricoid force should be measured, rather than estimated. 6,7 The use of a 30 Newton force, the recommended force in adults, can cause compression and distortion of the child’s airway, leading to airway obstruction and difficult intubation. 4,8 Furthermore, the age-dependent cricoid force necessary to prevent regurgitation is far less than 30 Newtons.…”

Surface anatomical landmarks or ultrasound for cricoid pressure application

“…The cricoid cartilage is identified and held between the thumb and middle fingers and the force is then applied by the index finger . Even with the recent use of sensors (to measure the exact force), the three‐finger manoeuvre is still the preferred technique . A 30‐N cricoid force results in a compression area approximately three times larger than the posterior surface of the cricoid cartilage, and effectively compresses the postcricoid hypopharynx (oesophageal entrance), as seen on magnetic resonance imaging and in videolaryngoscopic studies .…”