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

Abstract

The current study provides evidence that the median force necessary to occlude the esophageal entrance to prevent regurgitation is less in women compared with men. Applying the appropriate cricoid force in women should also decrease airway-related problems that tend to occur with the use of excessive forces. The findings of the current study may only be applicable to patients with normal body habitus.

Effect of cricoid pressure on the glottic view and intubation with king vision® video laryngoscope

“…[1425] Zeidan et al showed the median cricoid force for female is 18.7 N (95% confidence interval 17.1–20.3) and 30.8 N (95% confidence interval 28.15–33.5) for males suggesting that median force necessary to occlude esophageal entrance to prevent regurgitation is less in women. [26] Oh et al showed that CP with increasing force resulted in a worse laryngeal view with Pentax AWS. [27] Goldmann et al , in their study concluded that the laryngeal view with C-MAC VLS improved with CP, but the time required for intubation did not decrease in video laryngoscopy-guided CP.…”

Compelling Evidence for Effectiveness of Cricoid Pressure in Occluding the Esophageal Entrance: Where Do We Go From Here?

“…Although intensive training using technologyenhanced simulation can markedly improve proper application of the CP maneuver, 1 we believe the time has come for clinicians and researchers to rely on devices to obtain accurate measurement of the cricoid force. [4][5][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][4][5][6] Devices used in recent studies possess most of the features desired in an ideal device to measure the exact cricoid force.…”

“…[4][5][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][4][5][6] Devices used in recent studies possess most of the features desired in an ideal device to measure the exact cricoid force. 1,[4][5][6] Although aspiration of gastric contents can occur as a result of improperly applied CP, it can also occur before the application and after the release of correctly applied CP due to faulty techniques, 1,6 including failure to place a nasogastric tube before anesthetic induction when indicated, incomplete muscular relaxation, airway obstruction, excessive positive pressure ventilation, and premature endotracheal extubation.…”

“…[3][4][5][6] Devices used in recent studies possess most of the features desired in an ideal device to measure the exact cricoid force. 1,[4][5][6] Although aspiration of gastric contents can occur as a result of improperly applied CP, it can also occur before the application and after the release of correctly applied CP due to faulty techniques, 1,6 including failure to place a nasogastric tube before anesthetic induction when indicated, incomplete muscular relaxation, airway obstruction, excessive positive pressure ventilation, and premature endotracheal extubation. 1,6 Indeed, the successful use of the RSI technique is contingent on proper application of CP and attention to other variables that contribute to regurgitation and aspiration.…”

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.…”