The effect of cricoid pressure on intubation facilitated by the gum elastic bougie
Tracheal tube impingement is common during gum elastic bougie facilitated intubation and a 90° anti-clockwise rotation of the tube usually relieves it. We detail a case where this manoeuvre failed in the presence of cricoid pressure. We investigated the effect of cricoid pressure on gum elastic bougie facilitated intubation in 120 patients randomly allocated to receive sham cricoid pressure (n = 60) or 30 N cricoid pressure (n = 60). Impingement occurred in 23/60 (38%) with sham cricoid pressure and 36/60 (60%) with 30 N cricoid pressure (p < 0.025). Only females showed an increase in impingement with cricoid pressure: 29% sham cricoid pressure vs 63% 30 N cricoid pressure, p < 0.01, whereas the impingement in males was ∼ 60% in both groups. Ninety degree anti-clockwise rotation of the tube was successful in all 23 patients (100%) with sham cricoid pressure and in 32/36 patients (89%) with 30 N cricoid pressure. Releasing cricoid pressure relieved the obstruction in the four cases where 90° anti-clockwise rotation of the tube failed. Impingement is common and 90° anti-clockwise rotation is highly effective in both the presence and absence of cricoid pressure. In a small number of cases, cricoid pressure may cause the manoeuvre to fail.
Document Type: Research Article
Affiliations: 1: Senior House Officer in Anaesthesia, Department of Anaesthesia, James Cook University Hospital, Middlesbrough, UK 2: Consultant Anaesthetist, Wansbeck General Hospital, Ashington, Northumberland, UK
Publication date: May 1, 2007