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

Abstract

The 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 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 single-handed 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.