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Cricoid pressure: are two hands better than one?

T M Cook1

  • 1Department of Anaesthesia, Royal United Hospital, Bath.

Anaesthesia
|April 1, 1996
PubMed
Summary

One-handed cricoid pressure provides a significantly better view of the larynx during laryngoscopy compared to the two-handed method. This finding challenges the routine use of two-handed cricoid pressure for intubation.

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Area of Science:

  • Anesthesiology
  • Airway Management

Background:

  • Cricoid pressure is used during laryngoscopy to prevent aspiration.
  • Two-handed cricoid pressure has been advocated for improved intubation conditions.
  • The efficacy and impact of two-handed cricoid pressure on laryngeal view are debated.

Purpose of the Study:

  • To compare the laryngeal view during laryngoscopy using one-handed versus two-handed cricoid pressure.
  • To evaluate the impact of cricoid pressure technique on the need for airway adjuncts.

Main Methods:

  • A blinded crossover study involving 120 patients.
  • Comparison of laryngeal view using a 4-point scale with one-handed and two-handed cricoid pressure.
  • Assessment of the need for a gum elastic bougie for intubation.

Main Results:

  • No significant difference in laryngeal view grade on a 4-point scale between one-handed and two-handed cricoid pressure.
  • Significantly better laryngeal view with one-handed cricoid pressure when assessed with greater discrimination.
  • No significant difference in the requirement for a gum elastic bougie between the techniques.

Conclusions:

  • One-handed cricoid pressure yields a superior laryngeal view compared to two-handed technique.
  • The routine advocacy of two-handed cricoid pressure may not be justified.
  • Further evidence is needed to demonstrate advantages of two-handed cricoid pressure over one-handed technique.

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