Volume : 7, Issue : 1, January - 2018

ULTRASOUND EVALUATION OF OESOPHAGEAL COMPRESSION BY CLASSICAL CRICOID PRESSURE APPLICATION VERSES ULTRASOUND GUIDED COMPRESSION DURING RAPID SEQUENCE INDUCTION

Kiran Bhatia, Dr Shivkumar Singh, Dr Dheeraj Kapoor

Abstract :

<p>&nbsp;</p> <p class="MsoNormal"><b style="mso-bidi-font-weight:normal"><span lang="EN-IN" style="font-size:12.0pt;line-height:115%;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;&#10;color:black;mso-themecolor:text1">AIMS AND OBJECTIVE</span></b><span lang="EN-IN" style="font-size:12.0pt;line-height:115%;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;&#10;mso-fareast-font-family:&quot;Times New Roman&quot;"> The aim of our study was to investigate the functional impact of cricoid and paralaryngeal pressure respectively, on the outer anteroposterior (AP) diameter of the upper oesophagus at the cricoid cartilage level.</span><b style="mso-bidi-font-weight:&#10;normal"><span lang="EN-IN" style="font-size:12.0pt;line-height:115%;font-family:&#10;&quot;Times New Roman&quot;,&quot;serif&quot;;color:black;mso-themecolor:text1"> <o:p></o:p></span></b></p> <p class="MsoNormal"><b style="mso-bidi-font-weight:normal"><span lang="EN-IN" style="font-size:12.0pt;line-height:115%;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;&#10;color:black;mso-themecolor:text1">METHOD </span></b><span lang="EN-IN" style="font-size:12.0pt;line-height:115%;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;&#10;color:black;mso-themecolor:text1">The study was conducted by dividing subjects into two groups.In both groups ,</span><span lang="EN-IN" style="font-size:12.0pt;&#10;line-height:115%;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;mso-fareast-font-family:&#10;&quot;Times New Roman&quot;"> the image of the oesophagus was captured and stored in the system‘s memory.</span><span lang="EN-IN" style="font-size:12.0pt;line-height:&#10;115%;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;color:black;mso-themecolor:text1"> <o:p></o:p></span></p> <p class="MsoNormal"><span lang="EN-IN" style="font-size:12.0pt;line-height:115%;&#10;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;color:black;mso-themecolor:text1">Group 1 [n=30]</span><span lang="EN-IN" style="font-size:12.0pt;line-height:115%;&#10;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;mso-fareast-font-family:&quot;Times New Roman&quot;">Cricoid pressure was applied by one of the two anaesthetists</span><span lang="EN-IN" style="font-size:12.0pt;line-height:115%;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;&#10;color:black;mso-themecolor:text1"> .</span><span lang="EN-IN" style="font-size:&#10;12.0pt;line-height:115%;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;mso-fareast-font-family:&#10;&quot;Times New Roman&quot;">One <span style="mso-spacerun:yes">&nbsp;</span>anaesthetist <span style="mso-spacerun:yes">&nbsp;</span>localised the&nbsp;cricoid cartilage between the thumb and middle finger and applied gradual backwards pressure with the index finger until 30&nbsp;N was achieved</span><span lang="EN-IN" style="font-size:&#10;12.0pt;line-height:115%;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;color:black;&#10;mso-themecolor:text1"><o:p></o:p></span></p> <p class="MsoNormal"><span lang="EN-IN" style="font-size:12.0pt;line-height:115%;&#10;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;mso-fareast-font-family:&quot;Times New Roman&quot;">Group 2[n=30] Ultrasound imaging was performed on subjects placed in the supine position with the head extended and images were taken with pressure applied by the ultrasound probe and images taken .<span style="mso-spacerun:yes">&nbsp; </span><span style="mso-spacerun:yes">&nbsp;</span>.</span><span lang="EN-IN" style="font-size:&#10;12.0pt;line-height:115%;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;color:black;&#10;mso-themecolor:text1"><o:p></o:p></span></p> <p class="MsoNormal"><b style="mso-bidi-font-weight:normal"><span lang="EN-IN" style="font-size:12.0pt;line-height:115%;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;&#10;color:black;mso-themecolor:text1">RESULT </span></b><span lang="EN-IN" style="font-size:12.0pt;line-height:115%;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;&#10;color:black;mso-themecolor:text1">: It was seen that localization of oesophagus was mostly on the left side. Successful compression was seen in 75% of<span style="mso-spacerun:yes">&nbsp; </span>cases in manual classical CP whereas it was 100% in ultrasonography method. Classical CP method was also associated with more complications like tissue edema, aspiration due to inadequate compression etc.<o:p></o:p></span></p> <p class="MsoNormal"><b style="mso-bidi-font-weight:normal"><span lang="EN-IN" style="font-size:12.0pt;line-height:115%;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;&#10;color:black;mso-themecolor:text1">CONCLUSION :</span></b><span lang="EN-IN" style="font-size:12.0pt;line-height:115%;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;&#10;mso-fareast-font-family:&quot;Times New Roman&quot;"> It was found that CP does not effectively<span style="mso-spacerun:yes">&nbsp; </span>reduce the&nbsp;AP diameter of the oesophagus.</span><span lang="EN-IN" style="font-size:12.0pt;line-height:115%;&#10;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;color:black;mso-themecolor:text1"> Successful compression was seen in 75% of<span style="mso-spacerun:yes">&nbsp; </span>cases in<span style="mso-spacerun:yes">&nbsp; </span>classical CP whereas it was 100% in ultrasonography<span style="mso-spacerun:yes">&nbsp; </span>method. Classical CP method was also associated with more complications .Therefore it was concluded that use of ultrasound for oesophageal compression is a superior method.<b style="mso-bidi-font-weight:normal"><o:p></o:p></b></span></p>