Steinmann D, Priebe H-J
Anästhesiologische Universitätsklinik Freiburg, Hugstetter Str. 55, 79106, Freiburg.
Anaesthesist. 2009 Jul;58(7):695-707. doi: 10.1007/s00101-009-1548-6.
The vast majority of anaesthetists considers application of cricoid pressure for reasons of patient safety an integral part of rapid sequence induction. Cricoid pressure is applied with the idea that it will prevent regurgitation of gastric content into the pharynx, thereby reducing the incidence of pulmonary aspiration. This review describes the background of the introduction of cricoid pressure into clinical practice, analyzes published data concerning clinical relevance of perioperative pulmonary aspiration and efficacy of cricoid pressure in reducing it, discusses problems associated with its use, assesses knowledge and technical performance of cricoid pressure and presents various recent recommendations regarding application of cricoid pressure. The combination of complete lack of evidence for the efficacy of cricoid pressure in preventing pulmonary aspiration and numerous reports of clinically relevant interference with airway management during its use, seriously question the rationale of recommending the general use of cricoid pressure during rapid sequence induction.
绝大多数麻醉医生认为,出于患者安全考虑,在快速顺序诱导中应用环状软骨压迫是其不可或缺的一部分。应用环状软骨压迫的目的是防止胃内容物反流至咽部,从而降低肺误吸的发生率。本综述描述了环状软骨压迫引入临床实践的背景,分析了关于围手术期肺误吸临床相关性及环状软骨压迫降低误吸发生率有效性的已发表数据,讨论了其使用相关的问题,评估了环状软骨压迫的知识和技术操作,并提出了关于环状软骨压迫应用的各种最新建议。环状软骨压迫在预防肺误吸方面缺乏疗效的证据,且有大量关于其使用过程中对气道管理产生临床相关干扰的报道,这严重质疑了在快速顺序诱导中普遍推荐使用环状软骨压迫的合理性。