The determination of an effective cricoid pressure

Wraight, W. J.; Chamney, Anne R.; Howells, T. H.

doi:10.1111/j.1365-2044.1983.tb12078.x

Cited by 15 publications

(25 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, as the UOSP values with 20 N of cricoid force before insertion of the tracheal tube were similar to the corrected values after intubation, we believe that our results are still relevant to the clinical situation. Using a different methodology, but with a pillow beneath the occiput, previous workers have shown that a cricoid force of 44 N raised UOSP to 55 mmHg in 50% of their patients and to above 32 mmHg in all of them, and they also had a wide distribution of data [26]. Their mean baseline UOSP without cricoid pressure was much higher at 34 mmHg, however, they made no correction for the presence of the tracheal tube and a third of their patients were not paralysed.…”

Section: Discussionmentioning

confidence: 99%

Upper oesophageal sphincter pressure and the effect of cricoid pressure

et al. 1992

View full text Add to dashboard Cite

SummaryUpper oesophageal sphincter pressure has been measured in 24 patients with a sleeve device. The median sphincter pressure when awake was 38 mmHg. and when anaesthetised and paralysed was 6 mmHg. Afier tracheal intubation, cricoid pressure was applied at measured values between 5 and 50 N using a hand-held cricoid yoke while the sphincter pressure was recorded in two head and neck positions: with and without a standard intubating pillow with neck support. A cricoid ,force of 40 N increased sphincter pressure to above 38 mmHg in all the patients and the use of'the pillow did not alter this effect. With the application of' cricoid pressure, operating department assistants raised sphincter pressure to above 38 mmHg in only 50% of patients. Laryngoscopy made little dijerencp to the effect of cricoid pressure except in one patient in whom it reduced the sphincter pressure by 27 mmHg.

show abstract

Section: Discussionmentioning

confidence: 99%

Upper oesophageal sphincter pressure and the effect of cricoid pressure

et al. 1992

View full text Add to dashboard Cite

show abstract

“…Cricoid force may be inadequately or incorrectly applied, with subsequent morbidity and mortality [4], even among trained personnel [5,6]. There is debate about the optimal cricoid force required during induction of anaesthesia [2,[7][8][9][10], but it has been demonstrated that accurate, sustainable force can be delivered by using a cricoid yoke, even after minimal operator training [11,12].…”

Section: Introductionmentioning

confidence: 99%

The effect of mechanically‐induced cricoid force on lower oesophageal sphincter pressure in anaesthetised patients

et al. 2004

View full text Add to dashboard Cite

SummaryIn the United Kingdom, cricoid force is central to upper airway management in obstetric and emergency anaesthesia. A reduction in oesophageal barrier pressure (OBP) in these patients may increase regurgitation risk. This study investigated whether the application of cricoid force to anaesthetised patients reduced lower oesophageal sphincter pressure (LOSP) and consequently OBP. Anaesthesia was induced in 29 patients using a standard protocol. An oesophageal balloon catheter was inserted and gastric trace identified. The catheter was withdrawn incrementally and pressure readings recorded at each position before and during the application of 30 N cricoid force, with a sudden rise in pressure indicating lower oesophageal sphincter position. Oesophageal barrier pressure was calculated as the difference between LOSP and gastric pressure. Application of cricoid force significantly reduced OBP without influencing gastric pressure (p < 0.001). The use of cricoid force may increase the risk of gastroesophageal reflux in anaesthetised patients.

show abstract

“…Traditionally, a required force of 44 N has been taught and the force applied is often even greater than this [12]. This force was recommended by Wraight et al [13] as a cricoid force that would prevent regurgitation in 50% of patients with a theoretical maximum gastric pressure of 59 mmHg. Can we apply less force and still prevent regurgitation?…”

Section: Discussionmentioning

confidence: 99%

Airway obstruction with cricoid pressure

2000

View full text Add to dashboard Cite

SummaryCricoid pressure may cause airway obstruction. We investigated whether this is related to the force applied and to the technique of application. We recorded expired tidal volumes and inflation pressures during ventilation via a facemask and oral airway in 52 female patients who were anaesthetised and about to undergo elective surgery. An inspired tidal volume of 900 ml was delivered using a ventilator. Ventilation was assessed under five different conditions: no cricoid pressure, backwards cricoid pressure applied with a force of 30 N, cricoid pressure applied in an upward and backward direction with a force of 30 N, backwards cricoid pressure with a force of 44 N and through a tracheal tube. An expired tidal volume of < 200 ml was taken to indicate airway obstruction. Airway obstruction did not occur without cricoid pressure, but did occur in one patient (2%) with cricoid pressure at 30 N, in 29 patients (56%) with 30 N applied in an upward and backward direction and in 18 (35%) patients with cricoid pressure at 44 N. Cricoid pressure applied with a force of 44 N can cause airway obstruction but if cricoid pressure is applied with a force of 30 N, airway obstruction occurs less frequently (p ¼ 0.0001) unless the force is applied in an upward and backward direction.

show abstract

The determination of an effective cricoid pressure

Cited by 15 publications

References 21 publications

Upper oesophageal sphincter pressure and the effect of cricoid pressure

Upper oesophageal sphincter pressure and the effect of cricoid pressure

The effect of mechanically‐induced cricoid force on lower oesophageal sphincter pressure in anaesthetised patients

Airway obstruction with cricoid pressure

Contact Info

Product

Resources

About