Cricoid pressure with the Truview Evo2TM laryngoscope improves the glottic view

Abstract

Objective The Truview Evo2TM laryngoscope blade is designed to improve glottic view. This study was designed to evaluate the effect of cricoid pressure (CP) on laryngeal view and the ease of orotracheal intubation with the Truview Evo2 laryngoscope. Methods In this randomized controlled trial, 50 patients (American Society of Anesthesiologists physical status I-II, aged 18 to 60 yr) scheduled for elective surgery were enrolled. After induction of anesthesia and muscle paralysis, laryngoscopy was performed using the Truview Evo2 TM laryngoscope with the patient's head in the neutral position. In Group 1, the percentage of glottic opening (POGO) score was evaluated first without CP, then with CP, and CP was applied for intubation. In Group 2, the POGO score was evaluated first with CP, then without CP, and no CP was applied for intubation. Time to intubation and number of attempts required for intubation were also recorded. Results In 50 patients, the mean (standard deviation) POGO view obtained with the application of CP was 93% (10%) compared with 81% (19%) in patients without CP (P \ 0.01). Times to intubation were similar in the two groups: 14.2 (6.6) sec vs 14.0 (9.3) sec in Groups 1 and 2, respectively (P = 0.924). Sixteen percent of patients in Group 1 required a second attempt at tracheal intubation, while only 4% of patients in Group 2 required a second attempt (P = 0.162). Conclusion When using the Truview Evo2TM laryngoscope with the patient's head in the neutral position, application of CP improves the glottic view. This approach is not associated with increased difficulty in intubation.

Effect of cricoid pressure on laryngoscopic view and ease of intubation with Airtraq® laryngoscope

“…9,10,11,12 There are several studies depicting the effect of CP on glottic view and ease of intubation using conventional laryngoscopes and video laryngoscopes, whereas very few are available on the effect of CP on laryngoscopic view and ease of intubation using Airtraq® laryngoscope. 13,14,15,16 Waleed Riad and Tarek Ansari in their study concluded that CP neither prolongs the time nor interferes with ease of intubation using Airtraq®. 17 We studied the effect of CP on laryngoscopic view and ease of intubation with Airtraq® in 50 patients with clinically normal airway and observed that CP deteriorates the glottic view as evidenced by lower POGO scores during laryngoscopy.…”

Pressure measurement in the upper esophagus during cricoid pressure: A high‐resolution solid‐state manometry study

“…There are studies showing that CP may impair the airway during intubation . However, some studies have shown the opposite . Unfortunately, both anesthesiologists and anesthesia nurses often do apply the CP incorrectly, and are pressing on parts of the neck other than the cricoid cartilage .…”

The effect of cricoid pressure on tracheal intubation in adult patients: a systematic review and meta-analysis

“…Another 11 articles were excluded because of a crossover design (n = 2), tracheal intubation without the use of laryngoscopic approach (n = 6), non-RCT (n = 1), mere description of a study protocol (n = 1), and lack of data on the SFAIR (n = 1). Finally, a total of five full-text randomized trials (published between 2005 and 2018) 11,[18][19][20][21] were included in the current metaanalysis (Fig. 1).…”

“…All studies were conducted in the operating room. Four studies 11,[18][19][20] included patients without risks for aspiration and difficult airway scheduled for elective surgery without RSI during anesthetic induction. A trial that investigated 3,471 patients with risk for aspiration undergoing elective or emergent surgery with RSI reported intermediate risk for difficult intubation in up to approximately one third of patients.…”

“…A trial that investigated 3,471 patients with risk for aspiration undergoing elective or emergent surgery with RSI reported intermediate risk for difficult intubation in up to approximately one third of patients. 21 Two studies 11,21 specifically applied the bimanual technique (i.e., the assistant's hand was placed behind the neck) during airway management and two studies 18,19 adopted the onehand technique, while one study did not specify the technique. 20 Intubations were performed via the oral route in operating theaters with the use of neuromuscular blocking agents.…”