Licorice Root Resulting in Admission to the Intensive Care Unit

INTRODUCTION Patients commonly use herbal and food supplements and may often assume that a product is safe because it is “natural”; however, many of these products are just as dangerous as any prescription drug. This case report describes the admission of a patient to the intensive care unit after consumption of a food supplement containing licorice root (Glycyrrhiza sp.). The purpose of this report is to illustrate that commonly overlooked items in medication histories, such as food supplements, may lead to life-threatening complications. Detailed history-taking and investigation of herbal products identified in a medication history is essential to good pharmaceutical care

Cricoid Pressure Provides Incomplete Esophageal Occlusion Associated with Lateral Deviation: A Magnetic Resonance Imaging Study

Background: Cricoid pressure is a routine component of rapid sequence induction and is designed to reduce the risk of reflux and its associated morbidity. Recent studies have raised questions regarding the efficacy of cricoid pressure in terms of changes in the pharyngeal and esophageal anatomy. Objective: This current descriptive study was designed to observe the anatomical effect of cricoid pressure on the occlusion of esophageal lumen in conscious volunteers using magnetic resonance imaging (MRI). Methods: We quantitatively assessed esophageal patency before and during application of cricoid pressure in 20 awake volunteers utilizing MRI. Results: Target cricoid pressure was achieved in 16 of 20 individuals, corresponding to a mean percentage reduction in cricovertebral distance of 43% (range 25-80%). Cricoid pressure was applied incorrectly in 4 (20%) individuals as evidenced by no change in the cricovertebral distance. Incomplete esophageal occlusion was seen in 10 of 16, or 62.5% (95% confidence interval 35-85%) of individuals when appropriate cricoid pressure was applied. Incomplete esophageal occlusion was always associated with a lateral deviation of the esophagus. None of the 6 subjects with complete occlusion had esophageal deviation during the appropriate application of cricoid pressure. Conclusion: Effective application of cricoid pressure by an experienced operator frequently resulted in lateral deviation of the esophagus and incomplete occlusion of esophageal lumen. Reliance on cricoid pressure for esophageal occlusion requires further evaluation utilizing functional studies.</p