Assessment of effectiveness of cricoid pressure in preventing gastric insufflation during bag and mask ventilation: A randomized controlled trial
| Autor: | Govindarajalou Ramkumar, Suganya Srinivasan, Muthapillai Senthilnathan, Stalin Vinayagam, Arumugam Vasudevan |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Insufflation
Supine position medicine.medical_treatment Hypoxemia lcsh:RD78.3-87.3 03 medical and health sciences 0302 clinical medicine 030202 anesthesiology Cricoid pressure Medicine Intubation Antrum gastric antral area business.industry digestive oral and skin physiology 030208 emergency & critical care medicine ultrasonography respiratory system Rapid sequence induction medicine.disease digestive system diseases gastric insufflation Anesthesiology and Pain Medicine Pulmonary aspiration lcsh:Anesthesiology Anesthesia Original Article medicine.symptom business |
| Zdroj: | Saudi Journal of Anaesthesia Saudi Journal of Anaesthesia, Vol 12, Iss 4, Pp 606-611 (2018) |
| ISSN: | 0975-3125 1658-354X |
| Popis: | Background: Rapid sequence induction and intubation (RSII) with application of “Cricoid pressure ” and avoidance of “facemask ventilation ” (FMV) is believed to minimize the risk of pulmonary aspiration of gastric contents during general anesthesia. However, some patients may be at risk of developing hypoxemia and may benefit from FMV during RSII. The purpose of this study was to assess the effectiveness of “cricoid pressure ” in preventing gastric insufflation during FMV using gastric ultrasonography. Materials and Methods: Eighty-four adult patients were randomized to receive cricoid pressure (CP) or no cricoid pressure (NCP), during FMV after induction of general anesthesia. Gastric antral cross-sectional area (CSA) was measured with ultrasonography before and after FMV in supine and right lateral decubitus positions (LDP). Appearance of “comet tail ” artifacts created by acoustic shadows of gas in the gastric antrum was noted. Results: The incidence of insufflation indicated by “comet tail ” artifacts during FMV was lower in group CP (17 vs 71%; P < 0.001). The lowest Paw at which gastric insufflation occurred was higher in group CP (20 vs 14 cmH2O). The change in mean gastric antral CSA was significantly lower in group CP than in group NCP in supine (0.02 vs 0.36 cm2, P = 0.012) and right LDP (0.03 vs 0.67 cm2, P < 0.001). Conclusion: Cricoid pressure is effective in preventing gastric insufflation during FMV at Paw less than 20 cmH2O. Observation of comet tail artifacts in gastric antrum along with measurement of change in antral CSA on ultrasound examination is a feasible and reliable method to detect gastric insufflation. |
| Databáze: | OpenAIRE |
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