An instrument is described which, when used during the accelerated induction technique, ensures that consistent and adequate cricoid pressure can be applied. Mothers undergoing general anaesthesia for elective Caesarean section were studied in order to illustrate the clinical application of the instrument. The consequences to intubating conditions of applying adequate cricoid pressure, and an assessment of the instrument's control over the incidence of regurgitation during operation were investigated.

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Twenty-six patients manifesting severe pregnancy-induced (PIH) or pregnancy-aggravated (PAH) hypertension who presented for emergency Caesarean section under general anaesthesia were studied. All patients came from a previously identified high risk group--namely greater than 25 yr, multiparous and with diastolic arterial pressures sustained at greater than 120 mm Hg. Our standard accelerated induction technique for the management of severely hypertensive mothers was modified to include the use of fentanyl and droperidol before induction. This modification of the induction sequence produced a clinically significant amelioration of the reflex sympathetic hypertensive response to laryngoscopy and intubation in most mothers receiving antihypertensive therapy, without apparent deleterious effect in the immediate postoperative period to those neonates unaffected by intrauterine asphyxia.