Document Detail

Life-saving or ineffective? An observational study of the use of cricoid pressure and maternal outcome in an African setting.
MedLine Citation:
PMID:  19144507     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Cricoid pressure is a routine part of rapid-sequence induction of general anaesthesia in obstetrics, but its efficacy in saving life is difficult to ascertain. METHODS: As part of a prospective observational study of caesarean sections performed between January 1998 and June 2000 in 27 hospitals in Malawi, the anaesthetist recorded whether cricoid pressure was applied, the method of anaesthesia, the use of endotracheal intubation, the occurrence and timing of regurgitation and any other pre- or intra-operative complications. Logistic regression was used to assess the effect of cricoid pressure, type of anaesthetic and pre-operative complications on vomiting/regurgitation and death. RESULTS: Data were collected for 4891 general anaesthetics that involved intubation. Cricoid pressure was applied in 61%; 139 women vomited or regurgitated, but only 30 on induction of anaesthesia, in 24 of whom cricoid pressure was applied. There were 77 deaths, 11 of which were associated with regurgitation, in 10 of which regurgitation contributed to the death. Nine of the 11 mothers had cricoid pressure applied. Only one died on the table, the rest postoperatively. All those who died had preoperative complications. CONCLUSION: This study does not provide any evidence for a protective effect of cricoid pressure as used in this context, in preventing regurgitation or death. Preoperative gastric emptying may be a more effective measure to prevent aspiration of gastric contents.
P M Fenton; F Reynolds
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-01-13
Journal Detail:
Title:  International journal of obstetric anesthesia     Volume:  18     ISSN:  1532-3374     ISO Abbreviation:  Int J Obstet Anesth     Publication Date:  2009 Apr 
Date Detail:
Created Date:  2009-03-23     Completed Date:  2009-06-26     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9200430     Medline TA:  Int J Obstet Anesth     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  106-10     Citation Subset:  IM    
College of Medicine, Malawi.
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MeSH Terms
Anesthesia, General
Anesthesia, Inhalation
Anesthesia, Obstetrical / adverse effects*
Anesthetics, Inhalation
Cesarean Section
Cricoid Cartilage*
Gastric Emptying
Intubation, Intratracheal
Logistic Models
Prospective Studies
Respiratory Aspiration / epidemiology,  mortality,  prevention & control*
Risk Factors
Treatment Outcome
Vomiting / epidemiology
Young Adult
Reg. No./Substance:
0/Anesthetics, Inhalation; 151-67-7/Halothane
Comment In:
Int J Obstet Anesth. 2009 Apr;18(2):103-5   [PMID:  19233640 ]

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