Department of Anesthesiology, University of Louvain, St Luc Hospital, Brussels, Belgium.
Department of Anesthesia and Intensive Care Medicine, Liege University Hospital, Liege, Belgium.
Anaesthesia. 2019 Jan;74(1):22-28. doi: 10.1111/anae.14442. Epub 2018 Oct 4.
Cricoid force is widely applied to decrease the risk of pulmonary aspiration and gastric antral insufflation of air during positive-pressure ventilation, yet its efficacy remains controversial. We compared manual oesophageal compression at the low left paratracheal and cricoid levels for the prevention of gastric antral air insufflation during positive-pressure ventilation by facemask in patients scheduled for elective surgery under general anaesthesia. After gaining written consent, participants were randomly allocated by sealed envelope to one of three groups: oesophageal compression by 30 N paratracheal force (paratracheal group); oesophageal compression by 30 N cricoid force (cricoid group); or no oesophageal compression (control group). Gastric insufflation of air was assessed before and after positive-pressure ventilation by ultrasound measurement of the antral cross-sectional area and/or presence of air artefacts in the antrum. The primary outcome measure was the proportion of participants with ultrasound evidence of gastric insufflation. We recruited 30 patients into each group. Before facemask ventilation, no air artefacts were visible in the antrum in any of the participants. After facemask ventilation of the participant's lungs, no air artefacts were seen in the paratracheal group, compared with six subjects in the cricoid group and eight subjects in the control group (p = 0.012). Our results suggest that oesophageal compression can be achieved by the application of manual force at the low left paratracheal level and that this is more effective than cricoid force in preventing air entry into the gastric antrum during positive-pressure ventilation by facemask.
环甲膜施压广泛应用于正压通气以降低肺吸入和胃窦充气的风险，但它的效果仍存在争议。我们比较了在全身麻醉下择期手术患者使用面罩正压通气时，左甲状旁线低位和环甲膜水平手动食管压迫对预防胃窦充气的效果。在获得书面同意后，参与者通过密封信封被随机分配到三组之一：30N 甲状旁线压力食管压迫（甲状旁腺组）；30N 环甲膜压力食管压迫（环甲膜组）；或不进行食管压迫（对照组）。通过超声测量胃窦横截面积和/或胃窦内存在气影来评估正压通气前后的胃充气情况。主要结局指标是有超声证据表明胃充气的参与者比例。我们招募了每组 30 名患者。在任何参与者中，在面罩通气之前，胃窦内均未观察到气影。在面罩通气后，甲状旁腺组中没有气影，而环甲膜组中有 6 名，对照组中有 8 名（p=0.012）。我们的结果表明，通过在左甲状旁线低位施加手动压力可以实现食管压迫，并且与环甲膜压力相比，这在预防面罩正压通气时空气进入胃窦方面更有效。
