Cricoid Pressure Does Not Increase the Rate of Failed Intubation
by Direct Laryngoscopy in Adults
Anesthesiology 2005; 102:315-19
Turgeon, et al apply a double blind, randomized study conducted
at the Centre Hospitalier Affilie Universitaire de Quebec, involving 830
patients > 18 years old to evaluate the effect of applying cricoid pressure
(CP) during direct laryngoscopy and oral endotracheal tube placement. Over a 7 month period, 700 patients were
randomized into either a CP group and a sham CP group. There was no difference in gender, age, ASA
physical status, anthropometric characteristics, or risk factors for difficult
intubation. Additionally, the
distribution of the anesthesiologists and anesthesia assistants was comparable
. The primary endpoint was the rate of
failed intubation at 30 seconds; secondary endpoints included intubation time,
grade of laryngoscopic views, and Intubation Difficulty Scale score. Outcomes show similar rates of failed intubation
at 30 seconds, grades of laryngoscopic view and the Intubation Difficulty
Scale; while median intubation time was slightly longer in those who received
CP. Turgeon, et al conclude that CP,
whether provided by trained personnel or a sham technique does not increase the
rate of failed intubation. Therefore, if
CP use is indicated, one should not withhold the technique for fear of
increasing the difficulty of intubation.
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