Videolaryngoskopie zur modifizierten Rapid-sequence-Narkoseeinleitung : Sellick-Manöver mit und ohne videolaryngoskopische Kontrolle

Background. There is evidence that cricoid pressure, one of the key elements of rapid sequence induction (RSI) in patients at risk of aspiration, can distort the glottic view obtained by direct laryngoscopy (DL) and consequently impair or delay endotracheal intubation (ETI). The fact that cricoid pressure is applied by an assistant "blindly", i.e. without any visual feedback, is believed to be a contributing factor. Video laryngoscopy (VIL) offers the advantage that both the anaesthetist and the assistant can follow laryngoscopy. This could be useful for ETI during RSI. Methods. We used VIL for a simulated RSI in 170 adult patients randomised to either video laryngoscopy-guided application of cricoid pressure (group I) or conventional, i.e. "blind", application of cricoid pressure (group II). Time to ETI was compared between groups. The laryngoscopy view obtained by VIL was compared with the view of conventional DL obtained before, in all patients. Results. Time to ETI did not differ between groups (p=0.2): 25.1 ±14.2 s (group I) vs. 23.7±12.1 s (group II). Laryngoscopy scores were significantly better for VIL than conventional DL (p<0.001). Conclusions. Visualisation of the larynx during RSI can be improved using VIL. Time to ETI is not decreased by use of video laryngoscopy-guided application of cricoid pressure.