Time to change thinking on ‘cricoid pressure’

I don’t like cricoid pressure. Some people do. There is insufficient evidence that it is of any benefit. There is some consistent evidence that it worsens laryngoscopic view. In my clinical practice of critical care in and out of hospital, I can’t afford to risk delaying the securing of my patients’ airways with a procedure […]

Time to change thinking on ‘cricoid pressure’

Here’s my take on the role of ‘cricoid pressure’ in critical care intubation. Cautionary notice: This post represents my opinion on a topic about which airway practitioners seem to be divided. It is deliberately provocative in order to stimulate thinking and to challenge assumptions. It is not meant to offend or to divide professions or […]

Breaking with tradition in paediatric RSI

‘Traditional’ rapid sequence induction of anaesthesia is often described with inclusion of cricoid pressure and the strict omission of any artifical ventilation between paralytic drug administration and insertion of the tracheal tube. These measures are aimed at preventing pulmonary aspiration of gastric contents although there is no convincing evidence base to support that. However it […]

Palpating neonatal tracheal tubes

After neonatal intubation, the incidence of malposition of the tip of the tracheal tube is fairly high. A technique was evaluated involving palpation of the tube tip in the suprasternal notch, which in this small study was superior to insertion length based on a weight-based nomogram. The suprasternal notch was chosen because it anatomically corresponds […]

Atropine for Paediatric RSI?

In some areas it has been traditional to pre-medicate or co-medicate with atropine when intubating infants and children, despite a lack of any evidence showing benefit. It is apparently still in the American Pediatric Advanced Life Support (PALS) Provider Manual when age is less than 1 year or age is 1–5 years and receiving succinylcholine. […]

Resus Team Size and Productivity

A paediatric trauma centre study showed that in their system, seven people at the bedside was the optimum number to get tasks done in a paediatric resuscitation. As numbers increased beyond this, there were ‘diminishing marginal returns’, ie. the output (tasks completed) generated from an additional unit of input (extra people) decreases as the quantity […]