Cricoid Pressure to Control Regurgitation of Stomach Contents During Induction of Anæsthesia

Sellick, B.A.

doi:10.1016/s0140-6736(61)92485-0

Cited by 864 publications

(387 citation statements)

References 6 publications

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“…1 This maneuver was introduced in 1961 when there was great concern about the number of maternal deaths from anesthesia related aspiration. 7 The onus was upon the profession to do something about this problem and Sellick's approach seemed very reasonable Changes in glottic view with manipulation in comparison to control group.…”

Section: Discussionmentioning

confidence: 99%

The “BURP” maneuver worsens the glottic view when applied in combination with cricoid pressure

Snider

Clarke

Finucane

2005

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : The purpose of this study was to determine if the application of a BURP maneuver to the cricoid cartilage would combine the benefits of both the BURP and the Sellick maneuvers, resulting in an improved glottic view and offer the potential of protection against passive gastric regurgitation.M Me et th ho od ds s: : This was a double-blind, prospective, randomized, crossover trial. Forty-three patients scheduled for elective surgery participated in this study. General anesthesia was induced using fentanyl, propofol and rocuronium. In a random sequence for each case and blinded to the laryngoscopist, one of three maneuvers was carried out. Direct vertical pressure, using 30 newtons, a BURP maneuver with cricoid pressure, or no pressure was applied to the cricoid and the laryngoscopic view was ascertained. A separate laryngoscopy was conducted for each maneuver and the views were graded as good (part of the glottis seen), poor (only the arytenoids were seen) or no view (only the epiglottis was seen). Endotracheal intubation was then performed in each case. R Re es su ul lt ts s: :The results showed that the combination of the BURP maneuver and cricoid pressure worsened the view obtained at laryngoscopy in 30% of cases (P = 0.007). Cricoid pressure alone worsened the view in 12.5% of cases (P = 0.279). No difference was seen in 65% of cases. All patients but one were intubated easily.C Co on nc cl lu us si io on n: : There is no benefit to routinely applying a modified "BURP" maneuver to the cricoid cartilage during rapid sequence induction of anesthesia.

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Section: Discussionmentioning

confidence: 99%

The “BURP” maneuver worsens the glottic view when applied in combination with cricoid pressure

Snider

Clarke

Finucane

2005

Can J Anesth/J Can Anesth

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“…Clearly a compromise has to be made. Sellick originally recommended that, as thiopentone is injected, cricoid pressure is applied with light pressure [36] or with moderate pressure [6], until loss of consciousness when firm pressure is applied. As cricoid pressure compresses cricopharyngeus [S], the effects of both cricoid pressure and cricopharyngeal muscle tone must summate to give a higher UOSP before loss of consciousness than cricoid pressure alone, as the muscle does not completely relax until after loss of consciousness (Fig.…”

Section: Discussionmentioning

confidence: 99%

Upper oesophageal sphincter pressure and the intravenous induction of anaesthesia

et al. 1992

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SummaryThe upper oesophageal sphincter can prevent regurgitation of oesophageal contents into the pharynx following gastrooesophageal rejux in the awake patient. Upper oesophageal sphincter pressure was recorded with a Dent sleeve after hypnosis with midazolam (n = 7 ) and also during the rapid intravenous induction of anaesthesia with thiopentone ( n = 16) or ketamine (n = 7 ) . Thiopentone decreased mean(SD) sphincter pressure from an awake value of 43(19) to 9 ( 7 ) mmHg ( p < 0.001) and midazolam from 38(25) to 7 ( 3 ) mmHg ( p < 0.02). Mean(SD) sphincter pressures before and after ketamine were not significantly diflerent at 29( I S ) and 32(2I) mmHg respectively. After suxamethonium mean( S D ) sphincter pressure in all patients (n = 30) was 7 ( 4 ) mmHg. Laryngoscopy (n = 30) caused a small increase in meanlSD) sphincter pressure to 13(10) mmHg ( p < 0,001). Thiopentone caused a rapid fall in upper oesophageal sphincter pressure which usually started before loss of consciousness. These findings have implications for the timing of cricoid pressure application.

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“…HE concept of cricoid pressure (CP) was introduced by Sellick in 1961. 1 Since then it has become a standard of practice by most anesthesiologists as a technique employed to prevent passive regurgitation and aspiration of gastric contents during the induction of anesthesia in patients at high risk for regurgitation. 2,3 However, there continues to be controversy regarding the safety and efficacy of CP.…”

mentioning

confidence: 99%

The cricoid cartilage and the esophagus are not aligned in close to half of adult patients

Smith

Ladak

Choi

et al. 2002

Can J Anesth/J Can Anesth

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Cricoid Pressure to Control Regurgitation of Stomach Contents During Induction of Anæsthesia

Cited by 864 publications

References 6 publications

The “BURP” maneuver worsens the glottic view when applied in combination with cricoid pressure

The “BURP” maneuver worsens the glottic view when applied in combination with cricoid pressure

Upper oesophageal sphincter pressure and the intravenous induction of anaesthesia

The cricoid cartilage and the esophagus are not aligned in close to half of adult patients

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