4 - The use of cricoid pressure during anaesthesia

Summary

Key learning points

• Related anatomy and physiology of the upper respiratory tract

• Managing regurgitation and vomiting during anaesthesia

• The technique for applying cricoid pressure during anaesthesia

• Training practitioners to apply cricoid pressure

Sellick's Manoeuvre involves ‘pressure being externally exerted on the cricoid cartilage during anaesthetic induction in an attempt to prevent regurgitated stomach contents entering the lungs. This is effective due to the cricoid cartilage being a circular structure and when depressed occludes the oesophagus. Utilised during emergency situations when the patient may not have been fasted, even with fasting still has the potential to have maintained gastric contents

(Smith & Williams, 2004: 204)

Dr Brian Sellick first defined this technique for applying cricoid pressure during general anaesthesia in 1961.

In 1950 the Association of Anaesthetists of Great Britain and Ireland (AAGBI) examined deaths caused by pulmonary aspiration of gastric contents, which had long been recognised as a risk during anaesthesia. Forty-three deaths had been caused by regurgitation and aspiration. By 1956, there were a further 110 deaths attributable to aspiration of gastric contents (Sinclair & Luxton, 2005).

According to Owen et al. (2002), pressing on the lower part of the larynx to occlude the oesophagus was reported in medical literature as far back as the eighteenth century. In 1774, a doctor named Alexander Monro described an early form of cricoid pressure during experiments on cadaver subjects. The more modern technique still used today was described in 1961 by Dr Brian Sellick, an anaesthetist working in London.