Newly Published
Review Article  |   January 2017
Cricoid Pressure Controversies: Narrative Review
Author Notes
  • From the Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, Illinois (M.R.S., A.K.); Department of Anesthesiology, University of Illinois College of Medicine, Chicago, Illinois (M.R.S., G.J.C.); and Department of Anesthesiology, Procare Riaya Hospital, Al-Khobar, Kingdom of Saudi Arabia (A.Z.).
  • Submitted for publication March 9, 2016. Accepted for publication November 29, 2016.
    Submitted for publication March 9, 2016. Accepted for publication November 29, 2016.×
  • Research Support: Support was provided solely from institutional and/or departmental sources.
    Research Support: Support was provided solely from institutional and/or departmental sources.×
  • Competing Interests: The authors declare no competing interests.
    Competing Interests: The authors declare no competing interests.×
  • Correspondence: Address correspondence to Dr. Salem: 13675 Vanderbilt Drive, Unit 410, Naples, Florida 34110. mrsalem@sbcglobal.net. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Review Article / Airway Management / Respiratory System
Review Article   |   January 2017
Cricoid Pressure Controversies: Narrative Review
Anesthesiology Newly Published on January 5, 2017. doi:10.1097/ALN.0000000000001489
Anesthesiology Newly Published on January 5, 2017. doi:10.1097/ALN.0000000000001489
Abstract

Since cricoid pressure was introduced into clinical practice, controversial issues have arisen, including necessity, effectiveness in preventing aspiration, quantifying the cricoid force, and its reliability in certain clinical entities and in the presence of gastric tubes. Cricoid pressure–associated complications have also been alleged, such as airway obstruction leading to interference with manual ventilation, laryngeal visualization, tracheal intubation, placement of supraglottic devices, and relaxation of the lower esophageal sphincter. This review synthesizes available information to identify, address, and attempt to resolve the controversies related to cricoid pressure. The effective use of cricoid pressure requires that the applied force is sufficient to occlude the esophageal entrance while avoiding airway-related complications. Most of these complications are caused by excessive or inadequate force or by misapplication of cricoid pressure. Because a simple-to-use and reliable cricoid pressure device is not commercially available, regular training of personnel, using technology-enhanced cricoid pressure simulation, is required. The current status of cricoid pressure and objectives for future cricoid pressure–related research are also discussed.