CCP Podcast 010: Cricoid Pressure: Do it? Do it right? Or don’t do it at all?

 January 23

by Jonathan Downham

Cricoid pressure is the application of backwards pressure on the cricoid cartilage to occlude the oesophagus. Originally described by Sellick in 1961, he described how pressure applied at the level of the 5th cervical vertebrae obstructed the lumen of the oesophagus. This manoeuvre is performed to minimise the risk of gastric aspiration should the patient vomit during induction of anaesthesia.

The amount of force applied was discussed in an editorial in Anaesthesia with the recommendation that 10 Newtons should be applied when the patient is awake and then this should be increased to 30 Newtons once the patient has lost consciousness. Assistants can be trained using weighing scales.

Cricoid pressure can cause some problems:

 

  • Possibly ineffective
  • often poorly performed- users not aware of what correct pressure feels like.
  • Can obscure laryngoscopic view- larynx is often displaced laterally.
  • Risk of oesophageal rupture if patient vomits.
  • Excessive force may cause airway obstruction, which may block passage of the airway into the trachea.
  • Requires an additional assistant
  • May interfere with bimanual laryngoscopy
here is that Glidescope study
here is the latest comprehensive review of cricoid pressure
this is the French RCT underway 
this is Aussie RCT

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