Abstract
Performing cricoid pressure as originally described can interfere with laryngoscopy in that the assistant's hand can get in the way of the laryngocope handle as the blade is being inserted into the mouth. This is a particular hazard at induction for cesarean section because the enlarged breasts on a gravida's larger anteroposterior diameter aggravate the problem. Such interference with laryngoscopy can be alleviated by altering the position of the assistant's hand, applying the palmar surface of the hand to the anterior aspect of the chestwall. The palmar aspect of the index and middle finger, each slightly to either side of the middle of the arch of the cricoid cartilage, are used to press the cricoid posteriorly onto the esophagus. With the palm of the hand flat against the anterior chestwall, the laryngoscope handle can be manipulated without any difficulty in the conventional manner. There is an added advantage: it is more difficult for an overzealous assistant to exert extreme pressures, yet adequate pressures of 30 cm H2O can easily be reached.
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