Document Detail

The effect of cricoid pressure on intubation facilitated by the gum elastic bougie.
MedLine Citation:
PMID:  17448056     Owner:  NLM     Status:  MEDLINE    
Tracheal tube impingement is common during gum elastic bougie facilitated intubation and a 90 degrees anti-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 approximately 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 degrees anti-clockwise rotation of the tube failed. Impingement is common and 90 degrees 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.
U McNelis; A Syndercombe; I Harper; J Duggan
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Publication Detail:
Type:  Case Reports; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Anaesthesia     Volume:  62     ISSN:  0003-2409     ISO Abbreviation:  Anaesthesia     Publication Date:  2007 May 
Date Detail:
Created Date:  2007-04-23     Completed Date:  2007-06-07     Revised Date:  2007-10-09    
Medline Journal Info:
Nlm Unique ID:  0370524     Medline TA:  Anaesthesia     Country:  England    
Other Details:
Languages:  eng     Pagination:  456-9     Citation Subset:  AIM; IM    
Department of Anaesthesia, James Cook University Hospital, Middlesbrough, UK.
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MeSH Terms
Aged, 80 and over
Anesthesia, General
Anesthesia, Obstetrical
Cricoid Cartilage*
Intubation, Intratracheal / instrumentation,  methods*
Middle Aged
Sex Factors
Treatment Failure
Treatment Outcome
Comment In:
Anaesthesia. 2007 Aug;62(8):851-2; author reply 852   [PMID:  17635440 ]
Anaesthesia. 2007 Sep;62(9):967-8; author reply 968   [PMID:  17697231 ]

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