Cricoid pressure: Effects
Last updated: 06/06/2018
The cricoid maneuver was originally described by Sellick in 1961 to “control regurgitation until intubation with a cuffed endotracheal tube was complete” through “occlusion of the upper esophagus by backward pressure on the cricoid ring against the bodies of the cervical vertebrae to prevent gastric contents from reaching the pharynx.” Optimal applied pressure is 30-40N (lower pressures fail to occlude esophageal opening, and higher pressures are associated with complications), but multiple studies have demonstrated inconsistent application of cricoid pressure amongst physicians and nurses. In addition, there are reports of aspiration despite cricoid pressure and its use has been associated with complications including hypoventilation due to airway obstruction, difficult intubation due to distorted airway anatomy, relaxation of the lower esophageal sphincter, nausea and vomiting, and esophageal rupture.
However, it should also be noted that an ASA Closed Claims Database analysis from 1990-2007 found that 3% of closed claims were attributable to aspiration, and that damages awarded in cases where providers omitted cricoid pressure ($513,125) were significantly higher than those awarded where providers applied cricoid pressure ($211,500).
- Sellick BA. Cricoid pressure to control regurgitation of stomach contents during induction of anesthesia. Lancet. 1961;2:404-406. Link
- Beavers et al. Analysis of the application of cricoid pressure: implications for the clinician. Journal of Perianesthesia Nursing. 2009:24: 92-102. Link
- Clark et al. Assessment of cricoid pressure application by emergency department staff. Emergence Medicine Australasia. 2005; 17: 376-381. Link
- Schwartz DE, Matthay MA, Cohen NH. Death and other complications of emergency airway management in critically ill adults. A prospective investigation of 297 tracheal intubations. Anesthesiology 1995;82:367–76. Link
- Domino K, et al. Closed Claims’ Analysis. Best Practice & Research Clinical Anaesthesiology.2011;25: 263-276. Link
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