The Cricoid Force Necessary to Occlude the Esophageal Entrance: Is There a Gender Difference?.

BACKGROUND: We tested the hypothesis whether gender differences exist in the applied cricoid force necessary to prevent regurgitation. Real-time visual and dynamic means were used to assess the effectiveness of different applied cricoid forces in occluding the esophageal entrance in men (group 1) and in women (group 2). METHODS: In anesthetized and paralyzed patients, the glottis and esophageal entrance were visualized with a Glidescope video laryngoscope. Trained operators performed cricoid pressure (CP) and gastric tube insertion trials. Successful gastric tube insertion in the presence of CP was considered ineffective CP, whereas unsuccessful insertion was considered effective CP. The applied cricoid forces were measured with a novel instrument, the cricometer. The first patient in each group received 20 N. The applied cricoid force in successive patients was determined by the response of the previous patient within the same group, using the up-and-down sequential allocation technique. RESULTS: In the 30 men and 30 women who qualified for the study, the median cricoid force (cricoid force = 50) that occluded the esophageal entrance was 30.8 N (95% confidence interval = 28.15-33.5) in men, and 18.7 N in women (95% confidence interval = 17.1-20.3; P

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