The effect of cricoid pressure on intubation facilitated by the gum elastic bougie*

Abstract

SummaryTracheal tube impingement is common during gum elastic bougie facilitated intubation and a 90°a nti-clockwise rotation of the tube usually relieves it. We detail a case where this manoeuvre failed in the presence of cricoid pressure. We investigated the effect of cricoid pressure on gum elastic bougie facilitated intubation in 120 patients randomly allocated to receive sham cricoid pressure (n = 60) or 30 N cricoid pressure (n = 60). Impingement occurred in 23 ⁄ 60 (38%) with sham cricoid pressure and 36 ⁄ 60 (60%) with 30 N cricoid pressure (p < 0.025). Only females showed an increase in impingement with cricoid pressure: 29% sham cricoid pressure vs 63% 30 N cricoid pressure, p < 0.01, whereas the impingement in males was 60% in both groups. Ninety degree anti-clockwise rotation of the tube was successful in all 23 patients (100%) with sham cricoid pressure and in 32 ⁄ 36 patients (89%) with 30 N cricoid pressure. Releasing cricoid pressure relieved the obstruction in the four cases where 90°anti-clockwise rotation of the tube failed. Impingement is common and 90°anti-clockwise rotation is highly effective in both the presence and absence of cricoid pressure. In a small number of cases, cricoid pressure may cause the manoeuvre to fail.

Size of tracheal tubes

“…We have not reported these data in detail but stated in the Results section that vasopressors did not influence the accuracy of P tc CO 2 monitoring in our study patients. As mentioned in the discussion, these findings are in agreement with those of two recent studies [1,2] that also failed to find an influence of administered of vasopressors on P tc CO 2 measurements.…”

“…We would like to comment on McNelis and colleagues' article regarding tracheal tube impingement during gum elastic bougie facilitated intubation [1]. The authors chose to use 8.0-mm and 9.0-mm internal diameter tracheal tubes for their study.…”

Part 8: Adult Advanced Cardiovascular Life Support

“…[17][18][19][20] However, it also may impede ventilation and interfere with placement of a supraglottic airway or intubation. [21][22][23][24][25][26][27] The role of cricoid pressure during out-of-hospital cardiac arrest and in-hospital cardiac arrest has not been studied. If cricoid pressure is used in special circumstances during cardiac arrest, the pressure should be adjusted, relaxed, or released if it impedes ventilation or advanced airway placement.…”

Obstetric Anaesthetists’ Association and Difficult Airway Society Guidelines for the Management of Difficult and Failed Tracheal Intubation in Obstetrics

“…Incorrectly applied cricoid pressure can lead not only to a poor view at laryngoscopy but also to difficulties with insertion of the tracheal tube or SAD, mask ventilation and advancement of the tracheal tube over an introducer [82,[85][86][87][88]. Because of these concerns, there should be a low threshold to reduce or remove cricoid pressure should intubation or mask ventilation prove difficult; it should be removed for insertion of a SAD.…”