Abstract
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.
Keywords
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Article info
Publication history
Published online: June 13, 2011
Accepted:
May 19,
2011
Received in revised form:
August 17,
2010
Received:
June 12,
2010
Identification
Copyright
© 2012 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
