Upper oesophageal sphincter pressure and the effect of cricoid pressure.
Upper oesophageal sphincter pressure has been measured in 24 patients with a sleeve device. The median sphincter pressure when awake was 38 mmHg, and when anaesthetized and paralysed was 6 mmHg. After tracheal intubation, cricoid pressure was applied at measured values between 5 and 50 N using a hand-held cricoid yoke while the sphincter pressure was recorded in two head and neck positions: with and without a standard intubating pillow with neck support. A cricoid force of 40 N increased sphincter pressure to above 38 mmHg in all the patients and the use of the pillow did not alter this effect. With the application of cricoid pressure, operating department assistants raised sphincter pressure to above 38 mmHg in only 50% of patients. Laryngoscopy made little difference to the effect of cricoid pressure except in one patient in whom it reduced the sphincter pressure by 27 mmHg.
Vanner
R G
RG
Department of Anaesthetics, St Thomas' Hospital, London.
O'Dwyer
J P
JP
Pryle
B J
BJ
Reynolds
F
F
D000328:Adult; D000768:Anesthesia, General; D003413:Cricoid Cartilage / Q000502:physiology*; D004943:Esophagogastric Junction / Q000502:physiology*; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009126:Muscle Relaxation / Q000502:physiology; D011015:Pneumonia, Aspiration / Q000517:prevention & control*; D011187:Posture / Q000502:physiology