Does Cricoid Pressure Ease Fiberoptic Intubation

Abstract

The fiberoptic intubating bronchoscope has become increasingly important. These authors assessed reasons for the difficulty of advancing an endotracheal tube (ETT) over a fiberoptic bronchoscope during intubation and examined whether applying cricoid pressure facilitates ETT passage in a study of 50 healthy, elective-surgery patients aged 18 to 75 who were not expected to have difficult intubation. In the first part of the study, 10 patients underwent oral rapid sequence fiberoptic intubation, and a second nasal fiberscope was used to view the passage of the ETT. The ETT passed without difficulty in 3 patients, migrated into the hypopharynx in 4, and became impacted on the epiglottis in 1 and on the arytenoid cartilage in 2; in the latter 2 patients, the ETT was passed successfully after being rotated. In the second phase, 40 patients were randomized to undergo oral fiberoptic endotracheal intubation with or without cricoid pressure; intubation was successful in 63% and 33%, respectively (P=0.04). The authors concluded that cricoid pressure facilitates fiberoptic intubation. Comment: In the emergency department, patients have not fasted, and all must have cricoid pressure during intubation. Although this study is limited by the small number of patients and the exclusion of those with difficult airways, it suggests that cricoid pressure may enhance the success rates of fiberoptic intubation.