Cricoid pressure applied after placement of the laryngeal mask prevents gastric insufflation but inhibits ventilation

Abstract

We studied 50 patients, in a blind, crossover study, to assess if cricoid pressure applied after placement of the laryngeal mask prevented gastric insufflation without affecting ventilation. After induction of anaesthesia and neuromuscular block, a laryngeal mask was inserted and confirmed to be placed correctly. The lungs were ventilated with a maximum inflation pressure of 15 cm H2O. In the first 25 patients, expiratory volumes were measured with and without cricoid pressure (30 N). On both occasions, a free hand was placed under the patient's neck. In the next 25 patients, the effect of cricoid pressure on ventilation without support of the neck was also studied. The effect of cricoid pressure with support of the neck on gastric insufflation was then assessed using a stethoscope in all 50 patients, while the lungs were ventilated with a maximum inflation pressure of 30 cm H2O. At the end of the study, the position of the mask was re-assessed. Cricoid pressure significantly decreased mean expiratory volume (P << 0.001). This inhibitory effect was significantly greater when the pressure was applied without support of the neck (P << 0.001). Cricoid pressure significantly reduced the incidence of gastric insufflation (12 patients vs one patient; P << 0.001; 95% CI for difference 10.5-33.5%). In no patient was the mask dislodged after these procedures. Thus, although cricoid pressure applied after insertion of the laryngeal mask prevented gastric insufflation, it also decreased ventilation. The inhibitory effect of cricoid pressure on ventilation without support of the neck was greater than cricoid pressure with support of the neck.