Cricoid Pressure: Contradictory Evidence Regarding a Standard Practice

Abstract

The purpose of applying cricoid pressure is to prevent pulmonary aspiration of regurgitated gastric contents during airway management in mask‐ventilated patients who are at risk of aspiration. Providers may apply cricoid pressure during induction and intubation if they expect a difficult intubation or if the patient has a high risk for regurgitation. Although the application of cricoid pressure has been accepted as a standard practice worldwide, controversy persists because pulmonary aspiration can occur even when cricoid pressure is applied. The perioperative nurse should have thorough knowledge of the anatomy of the upper respiratory and gastrointestinal tracts, be able to demarcate the surface landmarks of the neck, and be skilled in applying cricoid pressure properly and safely. This article discusses cricoid pressure in the context of safe airway management as well as the perioperative nurse’s role as an assistant to the anesthesia professional when applying cricoid pressure.

Cricoid Pressure

“…Vomiting is an active act resulting from high intragastric pressure that causes abdominal wall contractions to open the esophageal sphincter (Dunn, 2022).…”

“…Performing cricoid pressure is contraindicated in patients with cervical spine trauma or fracture (actual or suspected), cervical arthritis, laryngeal or tracheal injury or mass and in patients who are actively vomiting, may have a foreign body in the airways, or a history of difficult airway management (Dunn, 2022).…”

“…Controversy regarding the benefits of cricoid pressure has been ongoing for more than two decades. It is unclear whether the results of the studies demonstrating potential harms associated with the application of cricoid pressure are the result of the maneuver itself or the maneuver being performed incorrectly (Dunn, 2022). Some researchers have found that the application of cricoid pressure may • Activate upper airway reflexes in semiconscious patients.…”

“…For more than 50 years, the Sellick maneuver , which is the application of cricoid pressure (Sellick, 1961), has been accepted as a standard component of general anesthesia (Dunn, 2022). Certified registered nurse anesthetists or anesthesiologists may ask plastic surgical nurses to apply cricoid pressure during the induction and intubation phases of general anesthesia if they anticipate a difficult intubation or if the patient presents with an increased risk for regurgitation (Dunn, 2022). Applying cricoid pressure prevents or reduces pulmonary aspiration of regurgitated gastric contents and air insufflation of the stomach (Sellick, 1961).…”

“…Pressure applied to the cricoid cartilage occludes the upper esophagus but allows the trachea to remain open (Sellick, 1961). Notably, excessive pressure can distort or deform this cartilage (Dunn, 2022).…”