Effect of cricoid pressure on tracheal intubation time during C-MAC video laryngoscopy: A Randomized Controlled Trial

Cricoid pressure is routinely used during rapid sequence induction; however, its impact on tracheal intubation when using either direct or video laryngoscopy has not been clearly established. Studies suggest that the use of cricoid pressure may prolong intubation time and increase the difficulty of intubation. We conducted a randomized controlled trial to assess the effect of cricoid pressure on tracheal intubation during C-MAC video laryngoscopy in adult patients scheduled for elective surgery.

A total of 100 adult patients scheduled for elective surgery under general anesthesia participated in this double-blind, randomized controlled trial. They were randomly assigned to two groups: the cricoid pressure group and the sham group, each consisting of 50 patients. The primary outcome of the study was intubation time, with secondary outcomes including the number of intubation attempts, percentage of glottic opening scores, Visual Analogue Scale for the difficulty of laryngoscopy or endotracheal tube advancement into the trachea, and postoperative hoarseness.

Demographic data and airway parameters were comparable across the two groups, with no significant differences. In the cricoid pressure group, the mean intubation time was marginally longer (35.6 ± 8.03 s) than the sham group (31.2 ± 9.36 s), with a mean difference of 4.42 seconds, which was statistically significant (P =  0.013). The number of intubation attempts, percentage of glottic opening scores, visual analogue scale, and postoperative hoarseness were similar between groups, with no statistically significant differences.

The application of cricoid pressure was associated with a prolongation of intubation time; however, the number of intubation attempts did not differ significantly.

Clinical Trials Registry-India (CTRI/2023/02/049436).