Controversias sobre la presión cricoidea o maniobra de Sellick / Controversial issue of cricoid pressure or Sellick maneuver

Introducción. La maniobra de Sellick o presión cricoidea es un procedimiento que se realiza de rutina en la profilaxis de la aspiración pulmonar como parte de la inducción/intubación de secuencia rápida. Ha sido objeto de múltiples controversias especialmente sobre su utilidad como práctica estándar de seguridad en el manejo de la vía aérea en urgencias. Se ha considerado la maniobra como una presión, sin embargo se designa la medida en Newton (N), sin tener en cuentael área del cartílago cricoides, de este modo es preciso referirse a la maniobra no en términos de presión cricoidea sino de fuerza cricoidea. Objetivo. Destacar la importancia de revisar las controversias que ha tenido una maniobra que se acerca a los 50 años de vigencia en el manejo de la vía aérea y la prevención de la broncoaspiración; incluso resaltar que ha habido errores en su descripción utilizando medidas de fuerza y no de presión Método. Mediante la revisión de la literatura se realiza este artículo de reflexión sobre las controversias de una maniobra usual en la práctica de urgencias del anestesiólogo, la Maniobra de Sellick. Conclusión. Desde 1961 cuando el doctor Brian Arthur Sellick describió la presión cricoidea como una maniobra útil para prevenir la regurgitación del contenido gástrico hacia la faringe, hasta la actualidad cuando se utiliza como medida importante en la técnica de inducción/intubación de secuencia rápida, se han venido encontrando una serie de controversias en cuanto a la seguridad que puede brindar en el manejo de la vía aérea, dignas de revisar y de discutir, y además, de recomendar una aclaración en cuanto a la designación de los términos presión y fuerza, que se han venido utilizando de manera indistinta para referirse a esta maniobra sin tener en cuenta el área del cartílago cricoides, que de hecho es diferente entre los individuos.

Introduction. The Sellick maneuver or cricoid pressure is a procedure that is routinely performed in the prophylaxis for pulmonary aspiration as part of a rapid sequence intubation. It has been considered very controversial specifically on its usefulness as a standard safety practice in the emergent airway management. Itusually has been considered a pressure maneuver, however it usually has seen assessed measuring Newtons (N) without considering the area of the cricoid cartilage. For this reason, it mustbe understood in terms of cricoid force instead of cricoid pressure. Objetive. To highlight the controversial issues this maneuver has had over the 50 years of its use in airway management and pulmonary aspiration prevention. To explain the common error of describing it in terms of force and not pressure. Methods. Literature review about the controversial aspects of the Sellick maneuver in emergent scenarios in anesthesia. Conclusion. Since the initial description by Dr. Brian Arthur Sellick in 1961 of the maneuver, using cricoid pressure to prevent them regurgitationof gastric contents to the pharynx used as part of the rapid sequence induction/ intubation, there have been multiple criticisms worthwhile to review, regarding the safety it provides in protecting the airway. We recommend that the terms pressure and force be differentiated and be used more appropriately when describing the maneuver, as the area of the cartilage should be considered in these measurements.

Effect of Parental Presence and Doctor's Conversation in Gastric Acidity and Volume Changes among Non - Crying Pediatric Surgical Patients / 대한마취과학회지

It has been already demonstrated by Cote and his collegues that the values of crying pts gastric pH were higher than those of noncrying pts. We have previously shown that the more patients cried, the higher gastric pH they had, and speculated that this effect may be resulted from the discharged stress through the crying. The present study was performed to examine the hypothesis that parental presence and doctors conversation prior to anesthesia influence the gastric acidity and volume changes. Ninety-one ASA class I or II children, 4 to 13 years of age, were selected randomly excluded 2nd or repeated operation, gastrointestinal operation and history of disease affecting gastric acidity and volume. And divided them into two groups by their status of parental presence and doctors conversation; parents presence (G-l, N=46) or not (G-2, N=45), doctor's comforting words(G-A, N=45) or not (G-B, N=46). These patients were further analyzed by combine factors of parental presence and doctors conversation; parental presence and doctors conversation (G-IA, N=25). parental presence and no conversation (G-1B, N=21), parent not present and conversation(G-2A, N=20) and parent not present and no conversation (G-2B, N=25). Those patients who had comforting words from their doctors were further divided by their response: poor response(G-i), good response(G-ii). All patients were premedicated with glycopyrrolate and hydroxyzine. Gastric samples were obtained through nasogastric tube and measured pH values with TOA pH METER MODEL HM-5ES(TOA Electronics Ltd., Tokyo, Japan) immediately after induction. The results were as follows; 1) Gastric pH; There were no statistical significances between groups(P>0.05) in the changes of the mean pH values. 2) Gastric volume; There were no statistical differences between groups(P>0.05) in the changes of the mean gastric volume(ml/kg). 3) Gastric pH and volume of the response of doctors conversation, There were no statistical difference of gastric pH and volume between good and poor response groups of doctors comfortmg words(P>0.05). From these results, we concluded that parental presence and doctors conversation did not influence the gastric acidity and volume statistically. However, clinically, these results might somehow influence the gastric acidity because the values of gastric pH of G-l(2.32+/-0.69) and G-A(2.38+/-0.64) were higher than of G-2(2.38+/-0.64) and G-B(2.18+/-0.53), and the value of gastric pH of G-IA(2.40+/-0.68) was highest and G-2B(2.15+/-0.43) was lowest.

Effect of the Amount of Crying on the Gastric Acidity and Volume in Pediatric Surgical Patients / 대한마취과학회지

It has been already demonstrated that the gastric acidity of crying pediatric surgical patients were less acidic than that of non-crying patients by Cote CJ and his collegues. Under the postulation that the changes of the gastric acidity and volume of crying patients might not be the same according to the amount of crying(duration or crying), this study was undertaken. 81 ASA physical status 1-2 children ages 1-14 for 1st elective operation except gastrointesti- nal surgery were selected randomly and divided into 2 groups and subdivided into 2 groups as follows: Group 1 (n=39~7, not cried Group 2 (n=42g cried Group A (n=14R cried in RR and OR Group B (n=28); cried in OR Subgoup B-1 (n= 11~7, cried as soon as arrived in OR Subgroup B-2 (n = 17); cried when attached monitoring and/or started IV All patients were premedicated with glycopyrrolate and hydroxyzine. Gastric samples were obtained through nasogastric tube and measured pH values with TOA PH METER MODEL HM-SES immediately after induction. The results were as follows; 1) Gastric pH In the changes of the mean pH values, there were statistical significances between groups 1 and 2(P or = 0.4 ml/kg) between groups 1 and 2, and between subgroups B-1 and B-2, but there were significant differences between groups A and B, and between group A and subgroup B-2 (p <0.05).