The effects of single‐handed and bimanual cricoid pressure on the view at laryngoscopy

Abstract

SummaryThe effects of two different methods of cricoid pressure on laryngoscopic view were studied in 94 healthy women presenting for routine gynaecological surgery. Laryngoscopy was performed with either single-handed or bimanual cricoid pressure; after grading of the view obtained, the other method was used and a second grading performed. Laryngoscopic view was better with the bimanual than with the single-handed technique (p = 0.016). In 21 cases, a better laryngoscopic view was obtained with the bimanual technique; in eight cases it was better with the singlehanded technique; and in 65 cases, the method of cricoid pressure made no difference. Age, weight, Mallampatti score and thyromental distance did not differ between patients in these three groups. Bimanual cricoid pressure should be the initial technique of choice during rapid sequence induction but, in a minority of cases, switching to a single-handed technique may improve the laryngoscopic view. The technique of cricoid pressure which produces the best laryngoscopic view in an individual patient cannot be predicted from the physical features studied.

Evaluation of an improved scoring system for the grading of direct laryngoscopy

“…Each laryngoscopy was graded using the standard Cormack and Lehane scoring system [1] and the modified system [6], which was in turn modified from that described by Wilson et al [3]. The two systems used are shown in Fig.…”

The effect of mechanically‐induced cricoid force on lower oesophageal sphincter pressure in anaesthetised patients

“…A later study of 94 women presenting for routine gynaecological surgery showed that the view obtained using bimanual cricoid force was as good as, or better than, that obtained using a single-handed technique in the majority of cases (91.5%). However, in 8.5% of patients the single-handed technique gave a better view [22]. The author also suggested that strong counter-pressure may compress or distort the laryngeal anatomy or distort the cervical spine.…”

“…The author also suggested that strong counter-pressure may compress or distort the laryngeal anatomy or distort the cervical spine. In his study, the assistant was instructed merely to resist any neck flexion that might be caused by anterior cricoid force [22]. It is therefore difficult to say which technique is preferable.…”

Orotracheal fibreoptic intubation for rapid sequence induction of anaesthesia*

“…Total intubation time (from removal of the facemask to the detection of carbon dioxide in the expired air after intubation) was recorded. Throughout the procedure, the anaesthetic nurse performed single-handed cricoid pressure [11], and a second assistant applied jaw thrust if required, on the advice of the anaesthetist performing the intubation. The number of attempts required to perform intubation and any dif®culties perceived by the operator were also recorded.…”