title: Cricoid pressure displaces the esophagus: an observational study using magnetic resonance imaging.
abstract: BACKGROUND
  Cricoid pressure (CP) is often used during general anesthesia induction to prevent passive regurgitation of gastric contents. The authors used magnetic resonance imaging to determine the anatomic relationship between the esophagus and the cricoid cartilage ("cricoid") with and without CP.
  
  
  METHODS
  Magnetic resonance images of the necks of 22 healthy volunteers were reviewed with and without CP. Esophageal and airway dimensions, distance between the midline of the vertebral body and the midline of the esophagus, and distance between the lateral border of the cricoid or vertebral body and the lateral border of the esophagus were measured.
  
  
  RESULTS
  The esophagus was displaced laterally relative to the cricoid in 52.6% of necks without CP and 90.5% with CP. CP shifted the esophagus relative to its initial position to the left in 68.4% of subjects and to the right in 21.1% of subjects. Unopposed esophagus was seen in 47.4% of necks without CP and 71.4% with CP. Lateral laryngeal displacement and airway compression were demonstrated in 66.7% and 81.0% of necks, respectively, as a result of CP.
  
  
  CONCLUSIONS
  In the absence of CP, the esophagus was lateral to the cricoid in more than 50% of the sample. CP further displaced both the esophagus and the larynx laterally.
authors.affiliation: Department of Anesthesia, St. Joseph's Healthcare and McMaster University, Hamilton, Ontario, Canada. kevandjo@sympatico.ca
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Smith
authors.forename: Julian
authors.initials: J
authors.lastname: Dobranowski
authors.forename: Gordon
authors.initials: G
authors.lastname: Yip
authors.forename: Alezandre
authors.initials: A
authors.lastname: Dauphin
authors.forename: Peter T-L
authors.initials: PT
authors.lastname: Choi
mesh_terms: D000328:Adult; D003413:Cricoid Cartilage / Q000033:anatomy & histology / Q000502:physiology*; D004947:Esophagus / Q000033:anatomy & histology / Q000502:physiology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D015588:Observer Variation; D011312:Pressure; D012016:Reference Values