title: The 50 ml syringe training aid should be utilized immediately before cricoid pressure application.
abstract: OBJECTIVE
  Cricoid pressure, applied during rapid sequence induction of anaesthesia, should be performed only by trained staff. Recommended training intervals vary from weekly to every 3 months, but this is unrealistic in day-to-day practice. Performance, when assessed, is often shown to be unacceptable before training. Unfortunately, most training aids are either expensive or unavailable. Assessment and training in previous studies was carried out on the same cricoid pressure simulator, introducing learning bias. In our study, we tested whether a 50 ml syringe utilized as a training aid immediately before the assessment of simulated rapid sequence induction on a different cricoid pressure simulator would improve staff performance.
  
  
  METHODS
  A total of 64 volunteers were randomly allocated into two equal groups. Group 1 (control group) was assessed on the cricoid pressure simulator only. Group 2 (training group) was pretrained to defined criteria using the 50 ml syringe. Next, the group was assessed on the cricoid pressure simulator.
  
  
  RESULTS
  A satisfactory force was applied in only 19% (6/32) of the control group, but in 47% (15/32) of the syringe pretrained group (P=0.03). Both groups applied, on average, excessive force.
  
  
  CONCLUSIONS
  Brief training with a 50 ml syringe will increase the likelihood of satisfactory force application during Sellick's manoeuvre. Applied to clinical practice, this will make cricoid pressure both more effective and reliable, and may improve patient safety. Therefore, the 50 ml syringe should be utilized before any clinical application of cricoid pressure.
authors: Department of Anaesthesia, Gartnavel General Hospital, Glasgow, Scotland, UK. a.kopka@doctors.org.uk
authors: Andreas
authors: A
authors: Kopka
authors: David
authors: D
authors: Robinson
mesh_terms: D000776:Anesthesiology / Q000193:education*; D003413:Cricoid Cartilage; D006801:Humans; D007442:Intubation, Intratracheal; D011312:Pressure; D013594:Syringes; D013663:Teaching / Q000379:methods*; D013664:Teaching Materials