Authors: Jonathan V. Roth, M.D.
Anesthesiology 1 2018, Vol.128, 233.
To the Editor:
In their excellent review, Salem et al.1 suggest that the dominant hand should be used to apply cricoid pressure (CP) because even though either hand can achieve adequate CP, the applied force may become inadequate if it needs to be sustained with the nondominant hand.2 I suggest that if there is any possibility that the person applying CP may be asked to perform a task that can be done with one hand (e.g., upper lip retraction, removal of stylet), the CP should be applied with the nondominant hand. I have noticed that if one ever asks that person to do something, they reflexively tend to use their dominant hand and thus may prematurely release CP, putting the patient at increased risk of aspiration. Ideally the person applying CP should not be asked to do anything else. However, sometimes one is in the situation where additional trained personnel are not available. Most airways are secured quickly enough that fatigue of the nondominant hand does not become an issue.
Salem, MR, Khorasani, A, Zeidan, A, Crystal, GJ Cricoid pressure controversies: Narrative review. Anesthesiology 2017; 126:738–52
Cook, TM, Godfrey, I, Rockett, M, Vanner, RG Cricoid pressure: Which hand? Anaesthesia 2000; 55:648–53