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First is to awaken the patient or the second option is to continue anesthesia via mask ventilation or LMA4, while an assistant maintains cricoid pressure.
By using the thumb and forefinger, the cricoid pressure will effectively close the esophagus until the cuffed endotracheal tube is established in the patient's airway.
Effect of cricoid pressure on the view at laryngoscopy.
Shortly after introducing the C-MAC device at our institution, the anaesthetic assistants felt that they were able to assist in obtaining better laryngoscopic views while maintaining cricoid pressure if they were able to see the screen of the video laryngoscope.
Brisson & Brisson (2010) suggest that perioperative practitioners often apply cricoid pressure incorrectly and this renders it ineffective.
Often, no one is providing cricoid pressure to assist with visualization of the larynx during attempted intubation, or coordinating compression and ventilation when needed.
At the time of difficulty in endotracheal intubation cricoid pressure was minimized as per instructions of the anesthetists.
Following pre-oxygenation for five minutes, rapid sequence induction with cricoid pressure was performed using propofol 180 mg and suxamethonium 160 mg.
In emergency situations where the gastric content is unknown Palmer et al (2000) and Levitan et al (2006) state that cricoid pressure (CP) is an additional technique that can be employed to protect the lungs from pulmonary aspiration during rapid sequence induction (RSI) and tracheal intubation.
A 3-person trauma team perform intubation, routinely applying cricoid pressure to prevent gastro-oesophageal reflux and aspiration, and manual in-line cervical stabilisation is required throughout the intubation procedure since protective devices are removed routinely.
During ventilation, cricoid pressure should be initiated if not done already, and should only be released once the patient is correctly intubated and the tube cuff has been inflated.