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British Journal of Anaesthesia, 1995, Vol. 74, No. 5 521-525
© 1995 The Board of Management and Trustees of the British Journal of Anaesthesia

research-article

Cricoid pressure impedes placement of the laryngeal mask airway

T. ASAI, MD, K. BARCLAY, MB, CHB, FRCA, I. POWER, BSC(HONS), MD, FRCA and R. S. VAUGHAN, MB, BS, FRCA

Department of Anaesthetics and Intensive Care Medicine, University of Wales College of Medicine Heath Park, Cardiff CF4 4XW

We have studied 22 patients to examine whether or not cricoid pressure affects ventilation of the lungs via the laryngeal mask and its correct positioning. In a randomized, crossover design, the laryngeal mask was inserted with or without cricoid pressure applied with a standardized force of 30 N using a cricoid yoke. A standardized pillow (6 cm in height) was placed under the patient occiput, but the neck was not supported. Ventilation of the lungs via the laryngeal mask was adequate in all patients when no cricoid pressurewas applied, but in only three of 22 patients when cricoid pressure was applied (P <<0.001 ; 95% confidence interval (Cl) 0.72–1.0). The mask was positioned correctly in 18 patients when no pressure was applied, and in none after application of cricoid pressure (P << 0.001; 95% Cl 0.66–0.98). We had planned to study, in an additional 20 patients, the effect of cricoid pressure without a pillow under the occiput; placement of the mask, however, was difficult even when cricoid pressure was not applied and there was a high incidence of bleeding from the oropharynx. We thus abandoned that part of the study after eight patients. In those eight patients, the success rate of ventilation via the laryngeal mask was lower when cricoid pressure was applied. We conclude that when sufficient force was applied, cricoid pressure, regardless of the method of application, did impede placement of the laryngeal mask. (Br. J. Anaesth. 1995; 74: 521–525)


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