Does Cricoid Pressure Interfere with Bougie-Facilitated Intubation?

Gum elastic bougie-assisted intubation is a valuable adjunct in the management of difficult airways. However, endotracheal tube advancement occasionally can be difficult, as the bevel of the tube can hang up at the level of the glottis. Rotating the tube 90 degrees counterclockwise often relieves this impingement. Researchers assessed the frequency of such impingement and the efficacy of the rotation maneuver in 120 patients who were randomized to intubation performed with a bougie and either sham cricoid pressure or true cricoid pressure applied in routine fashion.

The frequency of impingement was 38% with sham pressure and 60% with true cricoid pressure. This statistically significant difference was entirely attributable to an effect in female patients. The rotation maneuver was successful in relieving impingement in 100% of the sham pressure group but in only 89% of the true cricoid pressure group. The authors conclude that impingement is common and that cricoid pressure might limit the efficacy of the counterclockwise rotation maneuver.