Teaching anaesthetic nurses optimal force for effective cricoid pressure: a literature review.
OBJECTIVE
This literature review explores the role of force and education in cricoid pressure, an essential aspect of practice for any nurse within a critical care environment.


BACKGROUND
Cricoid pressure is utilized in everyday practice during rapid sequence induction (RSI) of anaesthesia. The purpose of cricoid pressure is to occlude the oesophagus in order to reduce the risk of acid aspiration during emergency induction of anaesthesia. The importance of best practice cannot be overstated because of high rates of mortality following acid aspiration.


METHODS
Literature searches were conducted using the key words cricoid pressure, Sellick manoeuvre, rapid sequence induction and acid aspiration syndrome. Articles were obtained from online searches, with literature published in the last 10 years being used; some seminal literature and textbooks were incorporated for definition purposes.


RESULTS
The literature displayed a disparity in practice and differing opinions on the optimal force to occlude the oesophagus. The role of education in correct application of cricoid pressure was explored, with unanimous conclusions that education plays a role in ensuring best practice.


CONCLUSIONS
Forces of 20-30 N are adequate to occlude the oesophagus and minimize the risk of acid aspiration. However, it is difficult for practitioners to accurately estimate this force in everyday practice. Various methods of assessing force were discussed, with the use of a 50-mL syringe suggested as a cost-effective and simple method to utilize in practice.


CONCLUSIONS
The literature review demonstrated that the subject of cricoid pressure is relevant in critical care practice in order to ensure patient safety during RSI. Thus, all critical care nurses have a duty to gain a working knowledge on the subject if patient safety is to be maintained. This paper provides a source of information on cricoid pressure and realistic methods of maintaining best practice.
University Hospital of Wales, Cardiff, UK. andrew.parry@cardiffandvale.wales.nhs.uk
Andrew
A
Parry
D000769:Anesthesia, Inhalation / Q000009:adverse effects / Q000379:methods / Q000451:nursing; D019985:Benchmarking; D001696:Biomechanical Phenomena; D002983:Clinical Competence; D003413:Cricoid Cartilage; D003422:Critical Care / Q000379:methods; D004630:Emergencies / Q000451:nursing; D004947:Esophagus; D006801:Humans; D009719:Nurse Anesthetists / Q000193:education* / Q000458:organization & administration; D024802:Nurse's Role; D009871:Operating Room Nursing / Q000193:education / Q000379:methods; D017410:Practice Guidelines as Topic; D011312:Pressure; D053120:Respiratory Aspiration / Q000209:etiology / Q000517:prevention & control*; D017751:Safety Management; D013594:Syringes; D013664:Teaching Materials