11: Does cricoid pressure reduce the risk of pulmonary aspiration?

Jan 3, 2020

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For our first episode of 2020, we investigate claims related to the application of cricoid pressure.

Claim 1. Cricoid pressure reduces the risk of pulmonary aspiration.

Claim 2. Landmark technique is able to accurately identify the cricoid cartilage.

Claim 3. Cricoid pressure should be routinely applied in all rapid-sequence intubations.

Our guest today is Dr. Jerome Crowley, an adult cardiothoracic anesthesiologist and intensivist at the Massachusetts General Hospital.

Connect with us @DepthAnesthesia on Twitter or depthofanesthesia@gmail.com.

Thanks for listening! Please rate us on iTunes and share with your colleagues.

Music by Stephen Campbell, MD.

References

Cricoid pressure to control regurgitation of stomach contents during induction of anaesthesia. Sellick BA. Lancet. 1961;2:404–406.

Smith KJ, Dobranowski J, Yip G, Dauphin A, Choi PT. Cricoid pressure displaces the esophagus: an observational study using magnetic resonance imaging. Anesthesiology. 2003;99:60–64.

Rice MJ, Mancuso AA, Gibbs C, Morey TE, Gravenstein N, Deitte LA. Cricoid pressure results in compression of the postcricoid hypopharynx: the esophageal position is irrelevant. Anesth Analg. 2009;109:1546–1552

Lee D, Czech AJ, Elriedy M, Nair A, El-Boghdadly K, Ahmad I. A multicentre prospective cohort study of the accuracy of conventional landmark technique for cricoid localisation using ultrasound scanning. Anaesthesia. 2018;73:1229–1234.

Smith CE, Boyer D. Cricoid pressure decreases ease of tracheal intubation using fiberoptic laryngoscopy (WuScope system. Can J Anesth. 2002;49:614–619.

The Effectiveness of Cricoid Pressure for Occluding the Esophageal Entrance in Anesthetized and Paralyzed Patients: An Experimental and Observational Glidescope Study. Anesth Analg. 2014 Mar;118(3):580-6. doi: 10.1213/ANE.0000000000000068.

Effect of cricoid pressure compared with a sham procedure in the rapid sequence induction of anesthesia: the IRIS randomized clinical trial. Birenbaum A, Hajage D, Roche S, et al; IRIS Investigators Group. JAMA Surg. 2019;154:9–17.

Flucker CJ, Hart E, Weisz M, Griffiths R, Ruth M. The 50-millilitre syringe as an inexpensive training aid in the application of cricoid pressure. Eur J Anaesthesiol 2000; 17: 443–447.

By listening to this podcast, you agree not to use information as medical advice to treat any medical condition in either yourself or others, including but not limited to patients that you are treating. Opinions expressed are solely those of the host and guests and do not express the views or opinions of Massachusetts General Hospital.