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Rebecca Ahlstrand - One of the best experts on this subject based on the ideXlab platform.

  • Pressure measurement in the upper esophagus during Cricoid Pressure a high resolution solid state manometry study
    Acta Anaesthesiologica Scandinavica, 2018
    Co-Authors: Richard Pellrud, Rebecca Ahlstrand
    Abstract:

    Background The use of Cricoid Pressure is controversial, and its ability to occlude the esophagus has been questioned. In this study, high-resolution solid-state manometry was used to analyze Pressure changes in the upper esophagus from Cricoid Pressure during modified rapid sequence induction. This is a secondary analysis of data from a previous study. Methods Seventeen healthy volunteers participated in a double-blind, randomized, placebo-controlled, cross-over study with primary aim to compare differences in the barrier Pressure on the lower esophageal sphincter during rapid sequence induction with or without alfentanil. Standardized Cricoid Pressure of 30 N was applied 2 minutes after propolipid injection and held for 15 seconds and Pressures in the esophagus were measured. Results Cricoid Pressure resulted in a Pressure increase of 127 ± 98 mmHg (95% CI: 73-182) (placebo) and 123 ± 74 mmHg (95% CI: 84-162) (alfentanil) at the level of the upper esophageal sphincter (UES), compared to baseline. The Pressure difference around the UES compared to the proximal esophagus during Cricoid Pressure application was 165 ± 100 mmHg (placebo) and 159 ± 87 mmHg (alfentanil) (mean ± 1 SD). Conclusion This study using high-resolution solid-state manometry under clinically relevant conditions shows that 30 N Cricoid Pressure generates high Pressure in the area of the UES, far exceeding the levels previously considered necessary to prevent regurgitation. Additional studies are needed to clarify the effectiveness of Cricoid Pressure in preventing passive regurgitation before it is rejected as a part of rapid sequence induction.

  • effects of Cricoid Pressure and remifentanil on the esophageal sphincters using high resolution solid state manometry
    Acta Anaesthesiologica Scandinavica, 2011
    Co-Authors: Rebecca Ahlstrand, Svenegron Thorn, Johanna Savilampi, Magnus Wattwil
    Abstract:

    BACKGROUND: Cricoid Pressure has been shown to decrease the Pressure in the lower esophageal sphincter (LES), increasing the risk of aspiration. Whether this reaction is due to pain associated with ...

R S Vaughan - One of the best experts on this subject based on the ideXlab platform.

  • British Journal of Anaesthesia 1995; 74: 521-525 Cricoid Pressure impedes placement of the laryngeal mask airway
    2015
    Co-Authors: T Asai, K Barclay, I Power, R S Vaughan
    Abstract:

    We have studied 22 patients to examine whether or not Cricoid Pressure affects ventilation of the lungs via the laryngeal mask and its correct positioning. In a randomized, crossover design, the laryngeal mask was inserted with or without Cricoid Pressure applied with a standardized force of 30 N using a Cricoid yoke. A standardized pillow (6 cm in height) was placed under the patient's occiput, but the neck was not supported. Ventilation of the lungs via the laryngeal mask was adequate in all patients when no Cricoid Pressure was applied, but in only three of 22 patients when Cricoid Pressure was applied (P <? 0.001; 95 % confidence interval (Cl) 0.72-1.0). The mask was positioned correctly in 18 patients when no Pressure was applied, and in none after application of Cricoid Pressure (P <? 0.001; 95 % Cl 0.66-0.98). We had planned to study, in an additional 20 patients, the effect of Cricoid Pressure without a pillow under the occiput; placement of the mask, however, was difficult even when Cricoid Pressure was not applied and there was a high incidence of bleeding from the oropharynx. We thus abandoned that part of the study after eight patients. In those eight patients, the success rate of ventilation via the laryngeal mask was lower when Cricoid Pressure was applied. We conclude that when sufficient force was applied, Cricoid Pressure, regardless of the method of application, did impede placement of the laryngeal mask. (Br. J. Anaesth

  • Cricoid Pressure applied after placement of the laryngeal mask prevents gastric insufflation but inhibits ventilation
    BJA: British Journal of Anaesthesia, 1996
    Co-Authors: T Asai, K Barclay, C Mcbeth, R S Vaughan
    Abstract:

    We studied 50 patients, in a blind, crossover study, to assess if Cricoid Pressure applied after placement of the laryngeal mask prevented gastric insufflation without affecting ventilation. After induction of anaesthesia and neuromuscular block, a laryngeal mask was inserted and confirmed to be placed correctly. The lungs were ventilated with a maximum inflation Pressure of 15 cm H2O. In the first 25 patients, expiratory volumes were measured with and without Cricoid Pressure (30 N). On both occasions, a free hand was placed under the patient's neck. In the next 25 patients, the effect of Cricoid Pressure on ventilation without support of the neck was also studied. The effect of Cricoid Pressure with support of the neck on gastric insufflation was then assessed using a stethoscope in all 50 patients, while the lungs were ventilated with a maximum inflation Pressure of 30 cm H2O. At the end of the study, the position of the mask was re-assessed. Cricoid Pressure significantly decreased mean expiratory volume (P

  • Cricoid Pressure impedes placement of the laryngeal mask airway
    BJA: British Journal of Anaesthesia, 1995
    Co-Authors: T Asai, K Barclay, I Power, R S Vaughan
    Abstract:

    We have studied 22 patients to examine whether or not Cricoid Pressure affects ventilation of the lungs via the laryngeal mask and its correct positioning. In a randomized, crossover design, the laryngeal mask was inserted with or without Cricoid Pressure applied with a standardized force of 30 N using a Cricoid yoke. A standardized pillow (6 cm in height) was placed under the patient occiput, but the neck was not supported. Ventilation of the lungs via the laryngeal mask was adequate in all patients when no Cricoid Pressurewas applied, but in only three of 22 patients when Cricoid Pressure was applied (P ≪0.001 ; 95% confidence interval (Cl) 0.72–1.0). The mask was positioned correctly in 18 patients when no Pressure was applied, and in none after application of Cricoid Pressure (P ≪ 0.001; 95% Cl 0.66–0.98). We had planned to study, in an additional 20 patients, the effect of Cricoid Pressure without a pillow under the occiput; placement of the mask, however, was difficult even when Cricoid Pressure was not applied and there was a high incidence of bleeding from the oropharynx. We thus abandoned that part of the study after eight patients. In those eight patients, the success rate of ventilation via the laryngeal mask was lower when Cricoid Pressure was applied. We conclude that when sufficient force was applied, Cricoid Pressure, regardless of the method of application, did impede placement of the laryngeal mask. (Br. J. Anaesth. 1995; 74: 521–525)

  • Cricoid Pressure impedes placement of the laryngeal mask airway and subsequent tracheal intubation through the mask
    BJA: British Journal of Anaesthesia, 1994
    Co-Authors: T Asai, K Barclay, I Power, R S Vaughan
    Abstract:

    We have studied 40 patients to see if Cricoid Pressure affects the success rate of ventilation through, and the position of, the laryngeal mask and subsequent fibrescope-aided tracheal intubation. Adequate ventilation of the lungs was produced through the laryngeal mask in 19 of 20 patients in the control group, but in only 10 of 20 patients in the Cricoid Pressure group (P

Daniel Y Ellis - One of the best experts on this subject based on the ideXlab platform.

  • AIRWAY/REVIEW ARTICLE Cricoid Pressure in Emergency Department Rapid Sequence Tracheal Intubations: A Risk-Benefit Analysis
    2015
    Co-Authors: Daniel Y Ellis, Tim Harris Facem, David Zideman Frca
    Abstract:

    Cricoid Pressure is considered an integral part of patient safety in rapid sequence tracheal intubation and emergency airway management. Cricoid Pressure is applied to prevent the regurgitation of gastric contents into the pharynx and subsequent aspiration into the pulmonary tree. This review analyzes the published evidence supporting Cricoid Pressure, along with potential problems, including increased difficulty with tracheal intubation and ventilation. According to the evidence available, the universal and continuous application of Cricoid Pressure during emergency airway management is questioned. An awareness of the benefits and potential problems with technique allows the practitioner to better judge when Cricoid Pressure should be used and instances in which it should be removed. [Ann Emerg Med. 2007;50:653-665.] 0196-0644/$-see front matte

  • Cricoid Pressure and laryngeal manipulation in 402 pre hospital emergency anaesthetics essential safety measure or a hindrance to rapid safe intubation
    Resuscitation, 2010
    Co-Authors: Tim Harris, Daniel Y Ellis, Liz Foster, David Lockey
    Abstract:

    Abstract Objectives This is the first study to look at the effects of Cricoid Pressure/laryngeal manipulation on the laryngeal view and intubation success in the emergency or pre-hospital environment. Cricoid Pressure is applied in the hope of reducing the incidence of aspiration. However the technique has never been evaluated in a randomized trial and may adversely affect laryngeal view. In order to improve intubating conditions Cricoid Pressure may be released and the larynx manipulated into a more favourable position. Methods We carried out a prospective observational study to evaluate the effects of Cricoid Pressure and laryngeal manipulation on laryngeal view in our physician led pre-hospital trauma service. Results 402 patients were included over a 16-month period. We intubated 98.8% patients on the first or second attempt. In 61 intubations (in 55 patients, 13.6%) the larynx required manipulation to facilitate intubation. In 22 intubations Cricoid Pressure was removed with the laryngeal view improving in 50%. Bimanual laryngeal manipulation was used in 25 intubations and the larynx better visualised in 60% of these. Backwards upwards rightwards Pressure was applied to the larynx in 14 intubations and the laryngeal view improved in 64%. Two patients regurgitated when Cricoid Pressure was released. Both had prolonged periods of bag valve mask ventilation and difficult intubations. Discussion The results suggest that Cricoid Pressure should be removed if the laryngeal view obtained is not sufficient to allow immediate intubation. Further manipulation of the larynx is likely to improve the chances of successful tracheal tube placement.

  • Cricoid Pressure in emergency department rapid sequence tracheal intubations a risk benefit analysis
    Annals of Emergency Medicine, 2007
    Co-Authors: Daniel Y Ellis, Tim Harris, David Zideman
    Abstract:

    Cricoid Pressure is considered an integral part of patient safety in rapid sequence tracheal intubation and emergency airway management. Cricoid Pressure is applied to prevent the regurgitation of gastric contents into the pharynx and subsequent aspiration into the pulmonary tree. This review analyzes the published evidence supporting Cricoid Pressure, along with potential problems, including increased difficulty with tracheal intubation and ventilation. According to the evidence available, the universal and continuous application of Cricoid Pressure during emergency airway management is questioned. An awareness of the benefits and potential problems with technique allows the practitioner to better judge when Cricoid Pressure should be used and instances in which it should be removed.

T Asai - One of the best experts on this subject based on the ideXlab platform.

  • British Journal of Anaesthesia 1995; 74: 521-525 Cricoid Pressure impedes placement of the laryngeal mask airway
    2015
    Co-Authors: T Asai, K Barclay, I Power, R S Vaughan
    Abstract:

    We have studied 22 patients to examine whether or not Cricoid Pressure affects ventilation of the lungs via the laryngeal mask and its correct positioning. In a randomized, crossover design, the laryngeal mask was inserted with or without Cricoid Pressure applied with a standardized force of 30 N using a Cricoid yoke. A standardized pillow (6 cm in height) was placed under the patient's occiput, but the neck was not supported. Ventilation of the lungs via the laryngeal mask was adequate in all patients when no Cricoid Pressure was applied, but in only three of 22 patients when Cricoid Pressure was applied (P <? 0.001; 95 % confidence interval (Cl) 0.72-1.0). The mask was positioned correctly in 18 patients when no Pressure was applied, and in none after application of Cricoid Pressure (P <? 0.001; 95 % Cl 0.66-0.98). We had planned to study, in an additional 20 patients, the effect of Cricoid Pressure without a pillow under the occiput; placement of the mask, however, was difficult even when Cricoid Pressure was not applied and there was a high incidence of bleeding from the oropharynx. We thus abandoned that part of the study after eight patients. In those eight patients, the success rate of ventilation via the laryngeal mask was lower when Cricoid Pressure was applied. We conclude that when sufficient force was applied, Cricoid Pressure, regardless of the method of application, did impede placement of the laryngeal mask. (Br. J. Anaesth

  • effect of Cricoid Pressure on placement of the i gel a randomised study
    Anaesthesia, 2014
    Co-Authors: Y Hashimoto, T Asai, Takero Arai, Y Okuda
    Abstract:

    We studied 40 adult patients to see if Cricoid Pressure affected placement of the I-gel(™). In a randomised crossover design, the i-gel was placed with and without Cricoid Pressure, and we compared the success rate of adequate ventilation through the i-gel, time to placement and the rate of optimal position of the device between the two circumstances. Cricoid Pressure significantly decreased the success rate of adequate ventilation through the i-gel (40 vs 34 patients) (p = 0.041, 95% CI for difference 4-26%), and significantly decreased the rate of the optimal position (39 vs 17 patients) (p < 0.001). The time to achieve adequate ventilation was significantly longer (p < 0.001) with Cricoid Pressure than without (median difference 8 s; 95% CI for median difference 3-12 s). Cricoid Pressure significantly decreases the success rate of ventilation through the i-gel, but the success rate of ventilation through the i-gel is reasonably high.

  • Cricoid Pressure applied after placement of the laryngeal mask prevents gastric insufflation but inhibits ventilation
    BJA: British Journal of Anaesthesia, 1996
    Co-Authors: T Asai, K Barclay, C Mcbeth, R S Vaughan
    Abstract:

    We studied 50 patients, in a blind, crossover study, to assess if Cricoid Pressure applied after placement of the laryngeal mask prevented gastric insufflation without affecting ventilation. After induction of anaesthesia and neuromuscular block, a laryngeal mask was inserted and confirmed to be placed correctly. The lungs were ventilated with a maximum inflation Pressure of 15 cm H2O. In the first 25 patients, expiratory volumes were measured with and without Cricoid Pressure (30 N). On both occasions, a free hand was placed under the patient's neck. In the next 25 patients, the effect of Cricoid Pressure on ventilation without support of the neck was also studied. The effect of Cricoid Pressure with support of the neck on gastric insufflation was then assessed using a stethoscope in all 50 patients, while the lungs were ventilated with a maximum inflation Pressure of 30 cm H2O. At the end of the study, the position of the mask was re-assessed. Cricoid Pressure significantly decreased mean expiratory volume (P

  • Cricoid Pressure impedes placement of the laryngeal mask airway
    BJA: British Journal of Anaesthesia, 1995
    Co-Authors: T Asai, K Barclay, I Power, R S Vaughan
    Abstract:

    We have studied 22 patients to examine whether or not Cricoid Pressure affects ventilation of the lungs via the laryngeal mask and its correct positioning. In a randomized, crossover design, the laryngeal mask was inserted with or without Cricoid Pressure applied with a standardized force of 30 N using a Cricoid yoke. A standardized pillow (6 cm in height) was placed under the patient occiput, but the neck was not supported. Ventilation of the lungs via the laryngeal mask was adequate in all patients when no Cricoid Pressurewas applied, but in only three of 22 patients when Cricoid Pressure was applied (P ≪0.001 ; 95% confidence interval (Cl) 0.72–1.0). The mask was positioned correctly in 18 patients when no Pressure was applied, and in none after application of Cricoid Pressure (P ≪ 0.001; 95% Cl 0.66–0.98). We had planned to study, in an additional 20 patients, the effect of Cricoid Pressure without a pillow under the occiput; placement of the mask, however, was difficult even when Cricoid Pressure was not applied and there was a high incidence of bleeding from the oropharynx. We thus abandoned that part of the study after eight patients. In those eight patients, the success rate of ventilation via the laryngeal mask was lower when Cricoid Pressure was applied. We conclude that when sufficient force was applied, Cricoid Pressure, regardless of the method of application, did impede placement of the laryngeal mask. (Br. J. Anaesth. 1995; 74: 521–525)

  • Cricoid Pressure impedes placement of the laryngeal mask airway and subsequent tracheal intubation through the mask
    BJA: British Journal of Anaesthesia, 1994
    Co-Authors: T Asai, K Barclay, I Power, R S Vaughan
    Abstract:

    We have studied 40 patients to see if Cricoid Pressure affects the success rate of ventilation through, and the position of, the laryngeal mask and subsequent fibrescope-aided tracheal intubation. Adequate ventilation of the lungs was produced through the laryngeal mask in 19 of 20 patients in the control group, but in only 10 of 20 patients in the Cricoid Pressure group (P

Magnus Wattwil - One of the best experts on this subject based on the ideXlab platform.