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SBURNSTEVEN SBURNSTEVEN (New Member)

Cricoid Pressure

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My preceptor held cricoid pressure while I intubated a patient considered a full stomach with RSI. After I intubated and inflated the cuff, my preceptor kept holding cricoid pressure and asked "Should I let go?" The answer was no but I didn't know why and can't find it when I try to look it up.....does anyone know why?

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Pressure should be held until you verify the ET is in the trachea. Once you are certain you have the ET in the right place then release pressure. Make sense?

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Technically your preceptor was asking, "are you in yet?"

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Pressure should be held until you verify the ET is in the trachea. Once you are certain you have the ET in the right place then release pressure. Make sense?
completely agree.

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Now that you have your answer, OP, you can ask your preceptor for convincing evidence that CP prevents aspiration on induction of GA.

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The main reason to apply cricoid pressure is to be able to check that box on documentation and hopefully not get sued if there's an aspiration. The cricoid pressure itself has been shown to decrease glottic exposure during laryngoscopy (means longer time until plastic is through the cords and the airway is protected), as well as potentially increasing rates of regurgitation. Also several MRI studies have shown that it does not reliably obstruct the esophagus (and this is when it is applied at the right place with the proper force, which it rarely is in practice).

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The main reason to apply cricoid pressure is to be able to check that box on documentation and hopefully not get sued if there's an aspiration.

Which is why, when designing your EMR or anesthesia forms (or re-ordering them), you don't include the cricoid pressure box at all.

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you have them let go once you confirm placement of ETT. Gold standard for confirmation of ETT is ETCO2 (at least 3 waveforms), bilateral breath sounds, and visualization of fog in the tube on expiration

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honestly I never have anyone give cricoid pressure. it usually makes your view worse. it also decreases lower esophageal sphincter tone, I've seen several articles that are debunking the use of cricoid pressure so I don't do it anymore

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I only apply cricoid pressure if it is a very anterior position, then release it when the tube goes through the cords. Holding cricoid for aspiration prevention is not EBP anymore, as several previous posted mentioned.

Cheers

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