Obstetric tracheal intubation guidelines and cricoid pressure – a reply
Notice bibliographique
Résumé
We thank Dr Priebe for his interest in our Obstetric Anaesthetists' Association and Difficult Airway Society guidelines for the management of difficult and failed tracheal intubation in obstetrics 1. One of our aims during writing the guidelines was to modernise the approach to obstetric general anaesthesia, in keeping with anaesthetic practice in the non-pregnant patient. In view of this, we have recommended many significant changes. Our literature search revealed a lack of robust evidence-based information, particularly in controversial areas, and therefore our group decided that it was necessary to produce guidelines based on expert consensus rather than high-level evidence. We decided that it was necessary to continue to recommend the use of cricoid pressure in the technique of rapid sequence induction, which is keeping with national or otherwise well-recognised non-obstetric and obstetric failed intubation guidelines in the UK, Canada, Italy and America 2-6. The use of cricoid pressure reflects UK practice, as shown in previous surveys 7, 8. On the other hand, we emphasise correct application of cricoid pressure, and early release of cricoid pressure during difficult laryngoscopy/tracheal intubation and for supraglottic airway device insertion. We have clarified that cricoid pressure may make airway management difficult, and that it is impossible to maintain cricoid pressure for prolonged periods of time. We wish to comment on Dr Priebe's point that cricoid pressure would not be introduced as a new technique were it to be assessed by the ADEPT process, as there is a lack of level 3b evidence for the use of cricoid pressure. The ADEPT process was described as a method of assessing and selecting new airway devices for introduction into hospitals 9. By definition, each use of a new device provides information, and hence such an assessment may be completed with a feasible number of patients 10. However, the incidence of pulmonary aspiration during obstetric general anaesthesia is sufficiently rare as to make a comparative assessment of the effect of cricoid pressure on this outcome virtually impossible (although there is suggestive evidence for its benefit in reducing regurgitation at induction in high-risk patients 11, 12). We are not introducing cricoid pressure into clinical practice, and therefore the burden of proof is on the safety of stopping its use rather than demonstrating its benefit. We would like to paraphrase Dr. Priebe's last sentence: ‘We need to prove that not using cricoid pressure in the obstetric population reduces difficulties and complications, compared to using optimised cricoid pressure, before we abandon it. We owe it to our patients.’
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».