The slides used by John Hinds as he destroyed cricoid pressure with his 'cricolol' parody during a debate at smaccGOLD. Posted on RAGE with a link to the audio here: http://ragepodcast.com/cricoid-press-press/
9. Cricolol: Early development
• Rebranded by Seamus O’Sellick in 1961
– 26 patients
– Single hospital observational study
– Non-randomised
– Non-standardised
– Dose was guessed
14. How much is in the ampoule?
105 trained perioperative nurses
• 5% correct dose
• No correlation between knowledge of
correct dose and actual dose given
(Seamus O’Kozial et al, AORN J 2000)
15. A half century of Evidence
No randomised controlled trials showing
benefit.
16. B.S.E.’s
• Quite good at making it difficult to pass
nasogastric tubes
• Quite good for nice pictures in healthy
volunteers having MRI scans
• Some nonsense with Dye
• Seems OK in dead bodies
19. Makes Airway management
more difficult
• Airway compression in 81%
(O’Smith et al, Anaesthesiology. 2003)
• Airway obstruction in 56%
(O’Hartsilver, Anaesthesia, 2000)
20. Reduces success with the tube
• Worsens laryngeal view in 29%
(O’Levitan et al, Anal Emerg Med 2006)
• Makes intubation process more difficult
(O’Allman KG. J Clin Anesth 1995)
21. Increases vomiting and
regurgitation
• Lowers oesophageal sphincter tone and
increases regurgitation
O’Garrad et al, Anaesthesia 2004
O’Chassard et al, Can J Anaesth 1996
22. Narrow therapeutic window
• Dose of 30mg recommended
– No idea what’s in the ampoule
• You might break the airway
(O’ Heath et al, Br J Anaesth 1996)
• Oesophagus might explode if dose
exceeds 44mg
(O’ Ralph, O’ Wareham, Anaesthesia 1991)
23.
24. Cricolol
• Evidence in well powered clinical trials
– None.
– Some BSE data
• Evidence of side effects includes:
– Airway collapse in most patients
– Complete airway obstruction in half of patients
– Increased difficulty of intubation
– Physical harm
37. Difficult Airway Society
• “Written guidelines should exist in each
department to cover a number of common
or serious airway problems”
• “An individual practitioner can make a
judgement about which
equipment/technique to use, and is quite
entitled to use any”
