Cricoid pressure applied after placement of laryngeal mask impedes subsequent fibreoptic tracheal intubation through mask.

Abstract

We studied 70 patients to see if cricoid pressure applied after insertion of the laryngeal mask altered the success rate of tracheal intubation through the mask. After induction of anaesthesia and neuromuscular blockade, patients were randomly allocated to have either cricoid pressure (Group C) or sham pressure (Group S). The view of the glottis through the laryngeal mask was assessed before and after the test pressure, and tracheal intubation through the mask was attempted using a fibreoptic bronchoscope. The test pressure did not alter the view of the glottis in any patient in group S, whereas it narrowed the glottic aperture in 16 out of 35 patients in group C. The fibrescope was inserted into the trachea in all patients in group S and in 25 patients in group C. The success rate of tracheal intubation in group S (31 patients) was significantly higher than in group C (21 patients, P << 0.001; 95% CI for difference: 9-48%). The time for insertion of the fibrescope in group S (median (95% CI): 12 (11-12) s) was significantly faster than in group C (16 (14-17) s, P << 0.001; 95% CI for difference: 3-6 s), and the time for tracheal intubation in group S (16 (15-18) s) was significantly faster than in group C (22 (19-24) s, P < 0.0005; 95% CI for difference: 3-7 s). Cricoid pressure after insertion of the laryngeal mask makes tracheal intubation through the mask significantly more difficult.