Cervical Spine Movements With Single-Handed Versus Bimanual Cricoid Pressure Under Simulated Cervical Immobilization: A Randomized Controlled Trial.

IF 2.7 2区医学 Q2 ANESTHESIOLOGY

Journal of neurosurgical anesthesiology Pub Date : 2026-06-24 DOI:10.1097/ANA.0000000000001141

Jeeva Kumar, Kiran Jangra, Chirag Ahuja, Divya Jain, Narender Kaloria, Shiv L Soni, Hemant Bhagat

{"title":"Cervical Spine Movements With Single-Handed Versus Bimanual Cricoid Pressure Under Simulated Cervical Immobilization: A Randomized Controlled Trial.","authors":"Jeeva Kumar, Kiran Jangra, Chirag Ahuja, Divya Jain, Narender Kaloria, Shiv L Soni, Hemant Bhagat","doi":"10.1097/ANA.0000000000001141","DOIUrl":null,"url":null,"abstract":"Background: Cricoid pressure is applied during intubation of full-stomach patients or in emergency situations, including trauma, oftentimes after excluding cervical spine injury. Cervical spine movements under cricoid pressure are mainly studied in cadavers.Methods: This prospective, randomized, assessor-blind trial (CTRI/2022/05/042505, dated May 12, 2022) enrolled adult ASA I and II patients with normal spines undergoing neurointerventional procedures with simulated cervical spine immobilization. Patients were randomized to single-handed or bimanual cricoid pressure (one hand anterior, the other providing posterior support below midcervical level). Cinefluoroscopic lateral images from occiput (C0) to C6 were obtained at baseline and during cricoid pressure. Angular displacement between adjacent cervical vertebrae was measured by a blinded radiologist. The primary outcome was maximal angular displacement at C4-C5. Secondary outcomes included segmental motion from C1 to C6, laryngoscopic view, intubation time and attempts, and hemodynamic responses.Results: Fifty patients (25 per group) were analyzed. Bimanual cricoid pressure showed significantly reduced angular displacement at C4-C5 (4.34±3.98 vs. 0.71±1.92, P=0.001). Similar findings observed at C1-C2 (4.34±4.45 vs. 0.89±1.97, P=0.001), C2-C3 (5.46±4.14 vs. 1.27±2.66, P=0.001), C3-C4 (5.66±4.52 vs. 1.51±1.72, P=0.001), and C5-C6 (3.04±4.44 vs. 0.18±2.19, P=0.006). Other secondary outcomes were comparable.Conclusions: During simulated cervical spine immobilization, bimanual cricoid pressure significantly reduces cervical spine movements without impairing intubation conditions. Posterior support likely counteracts spine movements caused by cricoid pressure.","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.7000,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of neurosurgical anesthesiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/ANA.0000000000001141","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Cricoid pressure is applied during intubation of full-stomach patients or in emergency situations, including trauma, oftentimes after excluding cervical spine injury. Cervical spine movements under cricoid pressure are mainly studied in cadavers.

Methods: This prospective, randomized, assessor-blind trial (CTRI/2022/05/042505, dated May 12, 2022) enrolled adult ASA I and II patients with normal spines undergoing neurointerventional procedures with simulated cervical spine immobilization. Patients were randomized to single-handed or bimanual cricoid pressure (one hand anterior, the other providing posterior support below midcervical level). Cinefluoroscopic lateral images from occiput (C0) to C6 were obtained at baseline and during cricoid pressure. Angular displacement between adjacent cervical vertebrae was measured by a blinded radiologist. The primary outcome was maximal angular displacement at C4-C5. Secondary outcomes included segmental motion from C1 to C6, laryngoscopic view, intubation time and attempts, and hemodynamic responses.

Results: Fifty patients (25 per group) were analyzed. Bimanual cricoid pressure showed significantly reduced angular displacement at C4-C5 (4.34±3.98 vs. 0.71±1.92, P=0.001). Similar findings observed at C1-C2 (4.34±4.45 vs. 0.89±1.97, P=0.001), C2-C3 (5.46±4.14 vs. 1.27±2.66, P=0.001), C3-C4 (5.66±4.52 vs. 1.51±1.72, P=0.001), and C5-C6 (3.04±4.44 vs. 0.18±2.19, P=0.006). Other secondary outcomes were comparable.

Conclusions: During simulated cervical spine immobilization, bimanual cricoid pressure significantly reduces cervical spine movements without impairing intubation conditions. Posterior support likely counteracts spine movements caused by cricoid pressure.

查看原文本刊更多论文

模拟颈椎固定条件下单手与双手压迫环状软骨的颈椎运动：一项随机对照试验。

背景：在全胃患者插管期间或在紧急情况下，包括创伤，通常在排除颈椎损伤后，应用环状膜压力。主要研究尸体在环状软骨压力下的颈椎运动。方法：这项前瞻性、随机、评估盲试验（CTRI/2022/05/042505，日期为2022年5月12日）招募了脊柱正常的成人ASA I和II患者，他们接受了模拟颈椎固定的神经介入手术。患者被随机分为单手或双手按压环状软骨组（一只手在前，另一只手在颈中水平以下提供后侧支撑）。从枕骨（C0）到C6的x线侧位图像在基线和环状软骨受压时获得。相邻颈椎之间的角位移由盲法放射科医生测量。主要终点是C4-C5的最大角位移。次要结果包括从C1到C6的节段性运动、喉镜观察、插管时间和插管次数以及血流动力学反应。结果：共分析50例患者，每组25例。双侧环状关节压力可显著降低C4-C5的角位移（4.34±3.98 vs. 0.71±1.92，P=0.001）。C1-C2组（4.34±4.45 vs. 0.89±1.97，P=0.001）、C2-C3组（5.46±4.14 vs. 1.27±2.66，P=0.001）、C3-C4组（5.66±4.52 vs. 1.51±1.72，P=0.001）、C5-C6组（3.04±4.44 vs. 0.18±2.19，P=0.006）也有类似的结果。其他次要结果具有可比性。结论：在模拟颈椎固定过程中，双手环状压迫明显减少颈椎运动，而不影响插管条件。后路支撑可能会抵消环状软骨压力引起的脊柱运动。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of neurosurgical anesthesiology 医学-临床神经学

CiteScore

6.20

自引率

10.80%

发文量

119

审稿时长

>12 weeks

期刊介绍： The Journal of Neurosurgical Anesthesiology (JNA) is a peer-reviewed publication directed to an audience of neuroanesthesiologists, neurosurgeons, neurosurgical monitoring specialists, neurosurgical support staff, and Neurosurgical Intensive Care Unit personnel. The journal publishes original peer-reviewed studies in the form of Clinical Investigations, Laboratory Investigations, Clinical Reports, Review Articles, Journal Club synopses of current literature from related journals, presentation of Points of View on controversial issues, Book Reviews, Correspondence, and Abstracts from affiliated neuroanesthesiology societies. JNA is the Official Journal of the Society for Neuroscience in Anesthesiology and Critical Care, the Neuroanaesthesia and Critical Care Society of Great Britain and Ireland, the Association de Neuro-Anesthésiologie Réanimation de langue Française, the Wissenschaftlicher Arbeitskreis Neuroanästhesie der Deutschen Gesellschaft fur Anästhesiologie und Intensivmedizen, the Arbeitsgemeinschaft Deutschsprachiger Neuroanästhesisten und Neuro-Intensivmediziner, the Korean Society of Neuroanesthesia, the Japanese Society of Neuroanesthesia and Critical Care, the Neuroanesthesiology Chapter of the Colegio Mexicano de Anesthesiología, the Indian Society of Neuroanesthesiology and Critical Care, and the Thai Society for Neuroanesthesia.