Cricoid pressure: Are two hands better than one?

One hundred and twenty patients were studied to compare the view of the larynx at laryngoscopy with one- or two-handed cricoid pressure applied. A blinded crossover technique was employed. When the grade of laryngeal view achieved with either type of cricoid pressure was compared using a 4-point scale there was no significant difference. However, when the views were compared with greater discrimination the laryngeal view achieved with one-handed cricoid pressure was significantly better than that seen with two-handed cricoid pressure. There was no significant difference between the groups in the need for a gum elastic bougie to facilitate intubation. A two-handed technique has been advocated to improve intubation conditions when cricoid pressure is required. It has several disadvantages, its efficacy has not been proven and this study suggests it does not improve the view at laryngoscopy. Two-handed cricoid pressure should no longer be advocated unless an advantage over one-handed cricoid pressure can be shown.