Can I have a bit of pressure?

Sellick BA. Cricoid pressure to control regurgitation of stomach contents during induction of anaesthesia. The Lancet 1961; 278: 404-406.

RHH Journal Club. July 12th, 2012. Dr Ilias Kanellopoulos

No free full-text available

Backward pressure of the cricoid cartilage against the cervical vertebrae is able to control regurgitation of stomach or oesophageal contents during induction of anaesthesia

Study design:

  • Single center (Harefield Hospital, Middlesex, London)
  • No control group

Materials and Methods:

  • 26 high risk for regurgitation cases
  • Single  group:
  1. Use of Ryle’s tube before induction
  2. Supine, slight head down tilt, head and neck fully extended
  3. RSI with barbiturate/muscle relaxant or inhalational induction
  4. Apply of cricoid  pressure
  • Outocome:  regurgitation of stomach or oesophageal contents into pharynx

Validity:

No randomized controlled trial:

  • No specific eligibility criteria
  • No random allocation to treatment groups
  • No defined therapies
  • No appropriate statistical analysis
  • No adequate sample size

Results:

  • In 23/26 cases no regurgitation or vomiting took place before, during or after cricoid pressure
  • In 3/26 cases release of  cricoid pressure after intubation was followed immediately by reflux => “in these cases cricoid pressure had been effective”

Conclusions/In Practice:

Cricoid pressure is a simple and universal technique for controlling regurgitation of stomach and oesophageal contents into pharynx during induction in anaesthesia

  • Recent research increasingly suggests that cricoid pressure may not be as advantageous as once thought because of potential risks
  • Physicians today need evidence (RCTs)  to support the use of cricoid pressure

 

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