Airway obstruction following application of cricoid pressure

doi:10.1016/0952-8180(91)90185-P

Journal of Clinical Anesthesia

Volume 3, Issue 5, September–October 1991, Pages 403-405

https://doi.org/10.1016/0952-8180(91)90185-P Get rights and content

Abstract

The widely practiced rapid-sequence induction with application of cricoid pressure is designed to facilitate endotracheal intubation in patients considered to be at high risk of aspiration. We describe a case in which this maneuver was performed on a patient with an undiagnosed traumatic injury to the larynx. The resulting airway obstruction required emergency surgical intervention. The clinical presentation, diagnosis, and management of such injuries are discussed.

References (11)

G.E. Lambert et al.
Laryngotracheal trauma: recognition and management
J Am Coll Emerg Phys
(1976)
R.S. Cicala et al.
Initial evaluation and management of upper airway injuries in trauma patients
J Clin Anesth
(1991)
H.H. Dash et al.
Blunt trauma to the cervical portion of the trachea
Br J Anesth
(1983)
G.S. Gussack et al.
Laryngotracheal trauma: a protocol approach to a rare injury
Laryngoscope
(1986)
T.H. Trone et al.
Blunt and penetrating laryngeal trauma: a 13 year review
Otolaryngol Head Neck Surg
(1980)

There are more references available in the full text version of this article.

Cited by (46)

Use of point-of-care ultrasound to assess esophageal insufflation during bag mask ventilation: A case report
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Citation Excerpt :
In 2017, Kei et al. showed that cricoid pressure could not prevent liquid from entering the esophagus [3]. In addition to having questionable efficacy, cricoid pressure is also associated with certain negative outcomes, such as cricoid cartilage fracture [11], airway obstruction [12], or an impaired laryngeal view during intubation [13]. Due to various controversies, the American Heart Association guidelines for adult advanced cardiovascular life support now discourage the routine use of cricoid pressure in cardiac arrest [14].
Bag-valve-mask ventilation is a basic airway management technique often used in patients with acute respiratory failure. Although highly effective in providing oxygenation and ventilation, this technique has been associated with gastric regurgitation and tracheal aspiration. In this case, the esophagus was visualized with bedside ultrasonography during bag-mask ventilation of an unresponsive and critically ill patient. Images were obtained both with and without cricoid pressure. Additionally, images were obtained during ultrasound-guided probe pressure on the lateral neck. Esophageal insufflation was identified consistently during bag mask ventilation. Cricoid pressure did not prevent esophageal insufflation. Ultrasound-guided probe pressure attenuated esophageal insufflation. This case depicts a unique instance of using a novel method to assess breath delivery during bag mask ventilation of a critically ill patient.
Difficult Airway Society 2015 guidelines for the management of unanticipated difficult intubation in adults: Not just another algorithm
2015, British Journal of Anaesthesia
Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults
2015, British Journal of Anaesthesia
Citation Excerpt :
Current evidence suggests that if applied correctly, cricoid pressure may improve the view on direct laryngoscopy.45 However, there are many reports demonstrating that it is often poorly applied, and this may make mask ventilation, direct laryngoscopy, or SAD insertion more difficult.46–52 If initial attempts at laryngoscopy are difficult during rapid sequence induction, cricoid pressure should be released.
These guidelines provide a strategy to manage unanticipated difficulty with tracheal intubation. They are founded on published evidence. Where evidence is lacking, they have been directed by feedback from members of the Difficult Airway Society and based on expert opinion. These guidelines have been informed by advances in the understanding of crisis management; they emphasize the recognition and declaration of difficulty during airway management. A simplified, single algorithm now covers unanticipated difficulties in both routine intubation and rapid sequence induction. Planning for failed intubation should form part of the pre-induction briefing, particularly for urgent surgery. Emphasis is placed on assessment, preparation, positioning, preoxygenation, maintenance of oxygenation, and minimizing trauma from airway interventions. It is recommended that the number of airway interventions are limited, and blind techniques using a bougie or through supraglottic airway devices have been superseded by video- or fibre-optically guided intubation. If tracheal intubation fails, supraglottic airway devices are recommended to provide a route for oxygenation while reviewing how to proceed. Second-generation devices have advantages and are recommended. When both tracheal intubation and supraglottic airway device insertion have failed, waking the patient is the default option. If at this stage, face-mask oxygenation is impossible in the presence of muscle relaxation, cricothyroidotomy should follow immediately. Scalpel cricothyroidotomy is recommended as the preferred rescue technique and should be practised by all anaesthetists. The plans outlined are designed to be simple and easy to follow. They should be regularly rehearsed and made familiar to the whole theatre team.
European Resuscitation Council Guidelines for Resuscitation 2015. Section 3. Adult advanced life support.
2015, Resuscitation
Complications of Managing the Airway
2013, Benumof and Hagberg's Airway Management
Complications of Managing the Airway
2012, Benumof and Hagberg's Airway Management: Third Edition

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^∗: Clinical/Research Fellow, Department of Anesthesia, Massachusetts General Hospital

^†: Instructor in Anaesthesia, Harvard Medical School, Boston, MA

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Case reportAirway obstruction following application of cricoid pressure

Abstract

J Am Coll Emerg Phys

J Clin Anesth

Br J Anesth

Laryngotracheal trauma: a protocol approach to a rare injury

Laryngoscope

Blunt and penetrating laryngeal trauma: a 13 year review

Otolaryngol Head Neck Surg

Case report
Airway obstruction following application of cricoid pressure