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UF scientists discover new explanation for controversial old patient-care technique
Date:10/20/2009

ea and the neck vertebrae.

It is most often used in accident victims whose stomachs might not be empty before surgery, or in patients who have bowel obstructions or slowed emptying of the stomach because of certain drugs or medical conditions.

Some doctors say that the procedure is hard to get right, and that not applying enough pressure and at a proper angle would cancel out any benefit.

A 2003 paper further cast strong doubt on the procedure's effectiveness with a finding that in 90 percent of cases, the esophagus moves to the side during the procedure. It is generally thought that the procedure is effective only if done at the midline of the neck. So researchers concluded that such movement of the esophagus means the maneuver can't effectively prevent regurgitation.

The UF researchers used open MRI imaging of the neck while the procedure was administered to volunteers. That allowed the person performing the technique to do so unimpeded, and increased the chance of reproducing how the procedure is carried out in a clinical setting.

It turns out, the imaging studies show, that the esophagus does not exist at that point in the neck where the procedure is done. Instead, it is a structure called the hypopharynx above the esophagus that gets pinched between the cricoid and the bones of the neck. The esophagus exists only lower down, near the shoulders. So movement of the esophagus doesn't affect the procedure since it is not involved, Rice and co-authors Lori Deitte, M.D., Anthony Mancuso, M.D., Nikolaus Gravenstein, M.D., Charles Gibbs, M.D., and Timothy Morey, M.D. found.

"This is a major error that's been in the literature for 50 years," said Rice, who is chief of liver transplantation in UF's department of anesthesiology.

As for the sideways movement, the study showed that the hypopharynx and cricoid structures move together, so effective compression is achieved even if it is pushed to the side i
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Contact: Czerne M. Reid
czerne@ufl.edu
352-273-5810
University of Florida
Source:Eurekalert

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