Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-10T08:28:59.212Z Has data issue: false hasContentIssue false
  • English
  • Français

Cricoid pressure: a simple, yet effective biofeedback trainer

Published online by Cambridge University Press:  23 December 2004

A. Kopka  and
J. Crawford
A. Kopka
Affiliation:
North Glasgow University Hospitals NHS Trust, Department of Anaesthesia, Western Infirmary, Glasgow, UK
J. Crawford
Affiliation:
North Glasgow University Hospitals NHS Trust, Department of Anaesthesia, Western Infirmary, Glasgow, UK
Get access

Abstract

Summary

Background and objective:Only regular training of anaesthetic personnel ensures safe and reliable application of cricoid pressure during rapid sequence induction of anaesthesia. Previously described training devices are either complicated, too expensive and usually unavailable, or they are very simple and do not correctly simulate the process of applying cricoid force. We designed and tested a cricoid pressure trainer with real-time display of applied force. The device is easy to assemble at relatively little cost with material widely available. It allows effective biofeedback training of the force required during the Sellick manoeuvre and can be used for routine staff assessment.

Methods:Thirty-six anaesthesia assistants were assessed for their correct application of cricoid pressure. Previous training in, and knowledge of, applying cricoid pressure was first evaluated by a questionnaire. We designed a model for testing the application of cricoid force. Pre-training cricoid forces were obtained by asking the subjects to apply ‘awake’ (10 N = 1.020 kg) and ‘asleep’ (30 N = 3.060 kg) cricoid pressure on our model while blinded to the actual pressure produced. The volunteer was then trained to apply correct pressure employing real-time biofeedback. Post-training values were later determined with the subject again blinded to the actual applied pressure.

Results:Post-training performance showed significant improvement in the application of the correct cricoid force (P<0.0005). Only 8% (3/36) of subjects applied incorrect ‘awake’ cricoid pressure after training vs. 56% (20/36) before training. All participants applied correct ‘asleep’ cricoid pressure after training vs. 72% (26/36) failing before training.

Conclusions:Our biofeedback cricoid pressure trainer is effective in the assessment and training of correct cricoid pressure application by anaesthetic personnel.

Keywords

EDUCATION, medicalGASTRO-OESOPHAGEAL REFLUXLARYNGEAL CARTILAGES, cricoid cartilage
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 21 , Issue 6 , June 2004 , pp. 443 - 447
Copyright
2004 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Salem MR, Sellick BA, Elam JO. The historical background of cricoid pressure in anaesthesia and resuscitation. Anesth Analg 1974; 53: 230–232.Google Scholar
Sellick BA. Cricoid pressure to control regurgitation of stomach contents during induction of anaesthesia. Lancet 1961; 2: 404–406.Google Scholar
Benhamou D. Cricoid pressure is unnecessary in obstetric general anaesthesia. Int J Obstet Anesth 1995; 4: 30–31.Google Scholar
Brimacombe JR, Berry AM. Cricoid pressure. Can J Anesth 1997; 44: 414–425.Google Scholar
Vanner RG, Asai T. Safe use of cricoid pressure. Anaesthesia 1999; 54: 1–3.Google Scholar
Allman KG. The effect of cricoid pressure application on airway patency. J Clin Anesth 1995; 7: 197–199.Google Scholar
Hartsilver EL, Vanner RG. Airway obstruction with cricoid pressure. Anaesthesia 2000; 55: 208–211.Google Scholar
Palmer JHM, Ball DR. The effect of cricoid pressure on the cricoid cartilage and vocal cords: an endoscopic study in anaesthetised patients. Anaesthesia 2000; 55: 263–268.Google Scholar
Hocking G, Roberts FL, Thew ME. Airway obstruction with cricoid pressure and lateral tilt. Anaesthesia 2001; 56: 825–828.Google Scholar
Heath KJ, Palmer M, Fletcher SJ. Fracture of the cricoid cartilage after Sellick's manoeuvre. Br J Anaesth 1996; 76: 877–878.Google Scholar
Ralph SJ, Wareham CA. Rupture of the oesophagus during cricoid pressure. Anaesthesia 1991; 46: 40–41.Google Scholar
Riffenburgh RH. Statistics in Medicine. San Diego, USA: Academic Press, 1999.
Lawes EG, Duncan PW, Bland B, Gemmel L, Downing JW. The cricoid yoke –a device for providing consistent and reproducible cricoid pressure. Br J Anaesth 1986; 58: 925–931.Google Scholar
Ashurst N, Rout CC, Rocke DA, Gouws E. Use of a mechanical simulator for training in applying cricoid pressure. Br J Anaesth 1996; 77: 468–472.Google Scholar
Owen H, Follows V, Reynolds KJ, Burgess G, Plummer J. Learning to apply effective cricoid pressure using a part task trainer. Anaesthesia 2002; 57: 1098–1101.Google Scholar
Flucker CJ, Hart E, Weisz M, Griffiths R, Ruth M. The 50-millilitre syringe as an inexpensive training aid in the application of cricoid pressure. Eur J Anaesthesiol 2000; 17: 443–447.Google Scholar
Clayton TJ, Vanner RG. A novel method of measuring cricoid force. Anaesthesia 2002; 57: 326–329.Google Scholar
Herman NL, Carter B, Van Decar TK. Cricoid pressure: teaching the recommended level. Anesth Analg 1996; 83: 859–863.Google Scholar
Meek T, Gittins N, Duggan JE. Cricoid pressure: knowledge and performance amongst anaesthetic assistants. Anaesthesia 1999; 54: 59–62.Google Scholar
Cook TM, Godfrey I, Rockett M, Vanner RG. Cricoid pressure: which hand? Anaesthesia 2000; 55: 648–653.Google Scholar
Vanner RG. Tolerance of cricoid pressure by conscious volunteers. Int J Obst Anesth 1992; 1: 195–198.Google Scholar