Cricoid versus paratracheal pressure as airway protective manoeuvres for oesophageal occlusion: A prospective randomised cross-over study.

BACKGROUND AND AIMS: Cricoid pressure (CP) is routinely used during rapid sequence induction to prevent aspiration, though its effectiveness remains debated. Paratracheal pressure (PP) has emerged as a possible alternative. This study compared CP and PP with respect to oesophageal occlusion and glottic visualisation using the Percentage of Glottic Opening (POGO) score.

METHODS

This is a prospective, randomised, cross-over study on 134 adult surgical patients (American Society of Anesthesiologists class I-II). Three anaesthesiologists participated in a blinded manner: One performed video laryngoscopy and nasogastric tube (NGT) insertion, the second applied CP or PP according to randomisation, and the third recorded outcomes. After induction, video laryngoscopy was performed, and a 16-Fr NGT insertion was attempted three times, first without pressure and then with either CP or PP for the next two attempts. Oesophageal occlusion was assessed by the inability to advance the NGT ≥15 cm. The POGO score was recorded for each attempt. Intubation and standard general anaesthesia followed.

RESULTS

CP demonstrated a significantly higher success rate of oesophageal occlusion compared with PP, with proportions n (%) of 128 (95.52%) and 109 (81.34%) (P < 0.001), respectively. The median (interquartile range) POGO scores of CP and PP were 90 (30) and 70 (30) (P < 0.001), respectively. The 95% confidence intervals of 80-90 and 60-80 for CP and PP, respectively, did not overlap, indicating a meaningful difference in glottic visualisation.

CONCLUSION

CP is more effective than PP in achieving oesophageal occlusion and provides better glottic visualisation. PP, however, with a significantly good success rate, is a reasonable alternative when CP is unsuitable.