Videographic Analysis of Glottic View With Increasing Cricoid Pressure Force - 21/03/13
, Youngjoon Chee, PhD d, Hyunggoo Kang, MD a, Youngsuk Cho, MD a, Jongshill Lee, PhD c, Dongwon Kim, MD b, Miae Jeong, MD b
Address for correspondence: Taeho Lim, MD, PhDRésumé |
Study objective |
Cricoid pressure may negatively affect laryngeal view and compromise airway patency, according to previous studies of direct laryngoscopy, endoscopy, and radiologic imaging. In this study, we assess the effect of cricoid pressure on laryngeal view with a video laryngoscope, the Pentax-AWS.
Methods |
This cross-sectional survey involved 50 American Society of Anesthesiologists status I and II patients who were scheduled to undergo elective surgery. The force measurement sensor for cricoid pressure and the video recording system using a Pentax-AWS video laryngoscope were newly developed by the authors. After force and video were recorded simultaneously, 11 still images were selected per 5-N (Newton; 1 N = 1 kg·m·s−2) increments, from 0 N to 50 N for each patient. The effect of cricoid pressure was assessed by relative percentage compared with the number of pixels on an image at 0 N.
Results |
Compared with zero cricoid pressure, the median percentage of glottic view visible was 89.5% (interquartile range [IQR] 64.2% to 117.1%) at 10 N, 83.2% (IQR 44.2% to 113.7%) at 20 N, 76.4% (IQR 34.1% to 109.1%) at 30 N, 51.0% (IQR 21.8% to 104.2%) at 40 N, and 47.6% (IQR 15.2% to 107.4%) at 50 N. The number of subjects who showed unworsened views was 20 (40%) at 10 N, 17 (34%) at 20 and 30 N, and 13 (26%) at 40 and 50 N.
Conclusion |
Cricoid pressure application with increasing force resulted in a worse glottic view, as examined with the Pentax-AWS Video laryngoscope. There is much individual difference in the degree of change, even with the same force. Clinicians should be aware that cricoid pressure affects laryngeal view with the Pentax-AWS and likely other video laryngoscopes.
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| Supervising editor: Richard M. Levitan, MD |
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| Author contributions: JO and TL conceived the study, designed the trial, and obtained research funding. Y. Chee, JL, TL, and Y. Cho developed the sensor and recording system. TL and HK supervised the trial conduct and data collection. JO, DK, and MJ undertook patient recruitment and managed the data, including quality control. JO drafted the article, and all authors contributed substantially to its revision. TL takes responsibility for the paper as a whole. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. The research fund of Hanyang University (HY-2010-MC) supported this article. |
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| Please see page 408 for the Editor's Capsule Summary of this article. |
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| A 27DBC22 survey is available with each research article published on the Web at www.annemergmed.com. |
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| Publication date: Available online January 8, 2013. |
Vol 61 - N° 4
P. 407-413 - avril 2013 Retour au numéro
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