Year : 2012  |  Volume : 1  |  Issue : 1  |  Page : 47-52

Cricoid pressure revisited

1 Associate Professor of Anaesthesiology, Kasturba Medical College, Manipal – 576 104, India
2 Associate Professor of Anaesthesiology, Srinivas Institute of Medical Sciences and Research, Srinivas Nagar, Mukka, Mangalore – 575 021, India
3 Assistant Professor of Anaesthesiology, Kasturba Medical College, Manipal – 576 104, India
4 Consultant Anaesthetist, Kurinji Hospital, Coimbatore – 641 028, India

Correspondence Address:
Shyamsunder Kamath
Associate Professor of Anaesthesiology, Kasturba Medical College, Manipal – 576 104
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Source of Support: None, Conflict of Interest: None

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Background: Cricoid pressure is used in rapid sequence intubation in patients with full stomach. Intubation may become difficult with adverse consequences with this manoeuvre, as laryngeal view may be altered. We used a cricoid device to standardise the cricoid pressure. Aim: To study the effectiveness of cricoid pressure delivered by a mechanical device in occluding the oesophagus (by visual assessment using a fibreoptic bronchoscope) and to assess the quality of laryngeal view after the application of cricoid pressure using a Macintosh laryngoscope. Patients and methods: 41 patients of ASA I and II, posted for elective surgery were enrolled in this prospective crossover study. They were randomly allocated to one of two interventions Intervention: A (with cricoid pressure) followed by Intervention B (without cricoid pressure) or intervention B followed by intervention A. Assessment of oesophageal opening and laryngeal grading was done. Assessor was blinded whether cricoid pressure was applied or not (cricoid device was designed to conceal the weight applied). Results: Oesophageal opening was occluded in 95% (39/41) of patients, with cricoid pressure and 88% (36/41) patients without cricoid pressure. 51% (21/41) of patients with cricoid pressure had worsening of laryngeal view. Whereas there was no change in 32% (13/41) of patients, there was improvement in 17% (7/41), with cricoid pressure. Conclusion: Irrespective of the cricoid pressure administered oesophageal opening appeared occluded in majority of the cases. Cricoid pressure delivered by cricoid device alters the quality of the laryngeal view.

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