Anesthesia Management: Do Not Use Cricoid Pressure with the i-gel Airway Device

Authors: Hashimoto Y et al., Anaesthesia 2014 Aug 69:878

Both insertion and ventilation with the i-gel are more successful without cricoid pressure.

To determine whether cricoid pressure affects placement or effectiveness of ventilation with the i-gel supraglottic airway device, researchers conducted a randomized crossover study of 40 healthy adults undergoing elective surgery. In each patient, the i-gel was placed by a single experienced investigator with and without application of cricoid pressure. Both cricoid pressure and sham pressure were applied by a trained assistant whose hands were draped.

Adequate ventilation through the i-gel was significantly more successful when cricoid pressure was not applied (100% vs. 85%). Fiber-optic examination showed that the rate of optimal i-gel positioning was also improved without cricoid pressure (98% vs. 43%), as was time to achieve adequate ventilation (median, 8 seconds shorter).

Comment

Cricoid pressure during laryngeal mask airway (LMA) insertion is of no proven benefit and is thought to hamper LMA placement primarily by compression or distortion of the hypopharynx. When using any LMA device, cricoid pressure should not be applied during either insertion or ventilation.