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Cricoid Pressure During Rapid Sequence Induction: Since its introduction by Sellick in 196P to prevent the passive regurgitation and aspiration of gastric contents, no randomized controlled study has ever been performed to prove that cricoid pressure has reduced mortality. A meta-analysis of 184 clinical trials failed to show any reduction in the incidence of pulmonary aspiration of gastric contents following rapid sequence induction.6 In countries where it is rarely used, the pulmonary aspiration rate is lower.7 Its disadvantages include an impairec view of the larynx, difficult intubation, laryngeal fracture anc esophageal rupture. Cricoid pressure is also associated witl an increased rate of failed intubation.8 Of note, in the patien with an unstable cervical spine, the recommended applicatioi of 40 Newtons of pressure may be dangerous. Furthermore radiological studies have shown that in over 50 percent of cases the esophagus is displaced laterally, allowing reflux to occur Application of cricoid pressure also causes reflex relaxation c the lower esophageal sphincter and may provoke vomiting, which is not reversed by the administration of metoclopramide. In many situations, cricoid pressure has to be released in ordt to permit tracheal intubation, thus negating the very benei
John H. Pennant, MB.B.S., F.R.C.A. Dallas, Texas
Girish RJoshi, MB.B.S., M.D., F.FA.R.C.S. Dallas, Texas
American Society of
Anesthesiologists
10
April 2009 Volume 73 Nurnbc
it is purported to offer. Perhaps it is time to re-evaluate this maneuver and instead induce our patients in a head-up position to prevent regurgitation of gastric contents.12
John H. Pennant, MB.B.S., F.R.C.A. Dallas, Texas
Girish RJoshi, MB.B.S., M.D., F.FA.R.C.S. Dallas, Texas
American Society of
Anesthesiologists
10
April 2009 Volume 73 Nurnbc
it is purported to offer. Perhaps it is time to re-evaluate this maneuver and instead induce our patients in a head-up position to prevent regurgitation of gastric contents.12