![]() ![]() RSII can cause hypotension due to several factors, including the rapid administration of anesthetic medications, the induction of anesthesia itself, and the intubation procedure.Whenever RSII is performed, a backup plan for airway management must be in place in case of an unanticipated difficult intubation.Preoperative airway evaluation should be performed, and if there is a concern for difficult intubation, an awake induction may be considered in place of RSII.Failed intubation occurs in 1 in 2,000 elective cases but increases to 1 in 300 for RSII.RSII is associated with an increased risk of difficulty in airway management.Additionally, strategies to lengthen the time to apneic oxygen desaturation may include passive apneic oxygenation using high-flow oxygen through a nasal cannula or continuous positive airway pressure preoxygenation.Desaturation may be prevented by ensuring adequate preoxygenation and using low-pressure (Hypoxia is the most common complication of RSII, particularly in patients with limited pulmonary reserve (i.e., critically ill, pregnant/peripartum, or obese patients).Other methods that may be used in place of or in adjunct to cricoid pressure to prevent aspiration include nasogastric tube placement and gastric ultrasound to assess the volume of gastric contents.Ultimately, more high-quality scientific evidence is needed to determine the effectiveness and safety of CP. ![]() ![]() Traditionally, the recommended amount of force for CP has been 30 Newtons (N), equivalent to approximately 3 kg of force.6 However, some studies have suggested that lower amounts of force may be sufficient to reduce the risk of aspiration while minimizing the potential for complications.However, there is no consensus on the optimal technique for cricoid pressure, including the amount of force used, the location of pressure application, and the patient position. Improper application of CP can interfere with intubation and increase the risk of complications. Another key factor in the use of CP is the competence of the provider in performing the procedure correctly.However, in other countries, the use of cricoid pressure is more controversial and used less frequently. In the United States, the use of cricoid pressure has become a standard of care for RSII, in part due to concerns about malpractice litigation.Additionally, in children and infants, airway patency may be compromised with over-excessive CP force due to increased compliance of the tracheal cartilage. The use of CP in RSII is a controversial topic in the anesthesia community due to limited evidence supporting its efficacy and concerns about its impact on time to intubation and visualization of the airway. ![]()
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