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Airway Management
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
To apply cricoid pressure correctly, the thyroid cartilage should be felt with the first finger and thumb and then moving inferiorly, the thin dip of the cricothyroid membrane leads on to the cricoid cartilage. To provide the 40 N of pressure described, a significant backward force should be applied, considering any concerns of cervical spine injury. It is for this reason that current teaching is moving towards the initial application of cricoid pressure, but gradual release if the initial view is compromised.
General anaesthesia
Published in Roy Palmer, Diana Wetherill, Medicine for Lawyers, 2020
The oesophagus (gullet), which lies behind the trachea, is the organ through which food passes to the stomach, and conversely the route by which gastric contents may be passively regurgitated or vomited. Inhalation of gastric contents may occur before intubation and if this occurs severe pulmonary damage can result. If the anaesthetist fears the presence of a full stomach an assistant should apply pressure over the cricoid cartilage—the cartilage immediately below the thyroid cartilage (the Adam’s apple) in the neck. Pressure over the cricoid squeezes the oesophagus during attempted intubation. This manoeuvre prevents passive regurgitation but does not prevent the escape of gastric contents during active vomiting. An alternative technique, favoured by the author, is to carry out intubation with the patient lying on their side. This allows any gastric material to escape through the mouth and it also avoids the difficulty frequently met with intubation during incorrectly applied cricoid pressure.
Practical Procedures
Published in Anthony FT Brown, Michael D Cadogan, Emergency Medicine, 2020
Anthony FT Brown, Michael D Cadogan
Placement with proofConfirm tube placement by: capnography to measure end-tidal carbon dioxide (ETCO2) – most reliabledirect visualization of endotracheal tube passing through the cordsauscultation over the lung fields and stomach.Release cricoid pressure once placement is confirmed.
A prospective randomized comparative study of Glidescope versus Macintosh laryngoscope in adult hypertensive patients
Published in Egyptian Journal of Anaesthesia, 2022
Salwa M. S. Hayes, Mahmoud M. Othman, Ahmed M. A. Bobo, Ibrahim A. Elbaser
Table 7 demonstrates the characteristics of the process of intubation in which external cricoid pressure was applied in 1 case only in G group while it was applied in 12 cases in M group with (p < 0.0001) and there was no need to change the blade from 3 to 4 in G group while it was needed in four patients in M group with no significant difference between both groups. Stylet was used in all patients in G group (100%) while it was applied only in eight cases in M group. The mean intubation time in G group was prolonged (26.44 ± 4.07 s) than in M group (19.18 ± 5.90 s). on the other hand, all cases in G group underwent successful intubation in the first trial while in M group, 40 cases showed first attempt success and the other 5 cases which showed no successful attempt in the first trial were intubated successfully after the second trial with significant difference between both studied groups.
Laryngoscopes for difficult airway scenarios: a comparison of the available devices
Published in Expert Review of Medical Devices, 2018
Legrand et al. [116] performed a randomized controlled study in which 60 anesthetists carried out three successive intubation attempts using conventional, Bullard, and Airtraq laryngoscopes in two simulated difficult airway scenarios: neck immobilization and neck immobilization with additional tongue edema. The results indicated that in a more difficult airway scenario, the Bullard and Airtraq laryngoscopes performed better than the conventional laryngoscope, with the Bullard device outstripping the Airtraq. In a study with cadavers with unrestricted and restricted C-spine mobility, the Bullard laryngoscope provided superior laryngoscopic views, comparable intubating times, and less C-spine movement than the GlideScope, Viewmax, or Macintosh laryngoscopes [117]. Shulman and Connelly [118] compared the Bullard laryngoscope with the flexible fiberoptic bronchoscope in a cervical spine injury model using inline stabilization and showed that the Bullard was more reliable, quicker, and more resistant to the effects of cricoid pressure than the flexible fiberoptic bronchoscope. The Bullard laryngoscope turned out to be useful both in normal and in difficult pediatric airways [119].
Video laryngoscopy-assisted tracheal intubation in airway management
Published in Expert Review of Medical Devices, 2018
Chia-Chih Liao, Fu-Chao Liu, Allen H. Li, Huang-Ping Yu
Rapid airway establishment is a major issue in emergency settings. Successful tracheal intubation in these settings requires a range of expertise resulted from continuous training and practice, and familiarity with airway devices. The rapid sequence technique is designed to facilitate rapid tracheal intubation in patients with an increased risk of gastric regurgitation and pulmonary aspiration. The procedures of the technique include pre-oxygenation, inducing rapid loss of consciousness followed by succinylcholine administration, application of cricoid pressure, and prevention of positive pressure ventilation. The main objective of this technique is to minimize the duration between the loss of airway reflexes and successful intubation with a cuffed endotracheal tube [68]. Rapid sequence intubation is widely practiced in patients with a full stomach or bowel obstruction and women who are pregnant [69].