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Cricoid Pressure Provides Incomplete Esophageal Occlusion Associated with Lateral Deviation: a Magnetic Resonance Imaging Study.
MedLine Citation:
PMID:  21669510     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Cricoid pressure is a routine component of rapid sequence induction and is designed to reduce the risk of reflux and its associated morbidity. Recent studies have raised questions regarding the efficacy of cricoid pressure in terms of changes in the pharyngeal and esophageal anatomy. OBJECTIVE: This current descriptive study was designed to observe the anatomical effect of cricoid pressure on the occlusion of esophageal lumen in conscious volunteers using magnetic resonance imaging (MRI). METHODS: We quantitatively assessed esophageal patency before and during application of cricoid pressure in 20 awake volunteers utilizing MRI. RESULTS: Target cricoid pressure was achieved in 16 of 20 individuals, corresponding to a mean percentage reduction in cricovertebral distance of 43% (range 25-80%). Cricoid pressure was applied incorrectly in 4 (20%) individuals as evidenced by no change in the cricovertebral distance. Incomplete esophageal occlusion was seen in 10 of 16, or 62.5% (95% confidence interval 35-85%) of individuals when appropriate cricoid pressure was applied. Incomplete esophageal occlusion was always associated with a lateral deviation of the esophagus. None of the 6 subjects with complete occlusion had esophageal deviation during the appropriate application of cricoid pressure. CONCLUSION: Effective application of cricoid pressure by an experienced operator frequently resulted in lateral deviation of the esophagus and incomplete occlusion of esophageal lumen. Reliance on cricoid pressure for esophageal occlusion requires further evaluation utilizing functional studies.
Authors:
Sylvain Boet; Kaylene Duttchen; Jean Chan; An-Wen Chan; William Morrish; Andre Ferland; Gregory M T Hare; Aaron P Hong
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-6-11
Journal Detail:
Title:  The Journal of emergency medicine     Volume:  -     ISSN:  0736-4679     ISO Abbreviation:  -     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-6-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8412174     Medline TA:  J Emerg Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011 Elsevier Inc. All rights reserved.
Affiliation:
Department of Anesthesia, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
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