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Anästhesiologische Universitätsklinik Freiburg, Hugstetter Str. 55, 79106, Freiburg.
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.
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