Cricoid pressure

Cricoid Pressure

Cricoid pressure being applied during intubation

Cricoid pressure, also known as Sellick's maneuver, is a technique used during endotracheal intubation to prevent the aspiration of gastric contents into the lungs. It involves applying pressure on the cricoid cartilage, a ring-shaped structure located at the base of the larynx.

Purpose

The primary purpose of cricoid pressure is to occlude the esophagus, preventing the regurgitation of stomach contents and reducing the risk of aspiration pneumonia. By applying pressure on the cricoid cartilage, the esophagus is compressed against the underlying vertebral bodies, effectively closing it off.

Technique

To perform cricoid pressure, the following steps are typically followed:

1. The patient is positioned in the sniffing position, which aligns the oral, pharyngeal, and laryngeal axes, facilitating intubation.
2. The person performing the procedure stands on the side of the patient's head.
3. The thumb and index finger are placed on either side of the cricoid cartilage, with the middle finger resting on the thyroid cartilage.
4. Pressure is applied in a posterior direction, compressing the cricoid cartilage against the underlying vertebral bodies.
5. The pressure is maintained throughout the intubation process until the endotracheal tube is successfully placed.

Controversies

While cricoid pressure is widely used, there are some controversies surrounding its effectiveness and potential complications. Some studies suggest that the pressure applied during cricoid pressure may not be sufficient to completely occlude the esophagus, leading to the possibility of aspiration. Additionally, there have been concerns about the potential for complications such as difficulty in visualizing the vocal cords during intubation or the risk of esophageal rupture.

Alternatives

In recent years, alternative techniques have been proposed as alternatives to cricoid pressure. These include the use of video laryngoscopy, which provides a better view of the airway and reduces the need for external pressure. Another technique is the use of a supraglottic airway device, which can help maintain airway patency without the need for cricoid pressure.

Conclusion

Cricoid pressure, or Sellick's maneuver, is a technique used during endotracheal intubation to prevent the aspiration of gastric contents. While it is a widely practiced technique, there are ongoing debates regarding its effectiveness and potential complications. As with any medical procedure, it is important for healthcare professionals to stay updated on the latest evidence and guidelines to ensure patient safety.

See Also

• Endotracheal Intubation
• Aspiration Pneumonia
• Sniffing Position
• Video Laryngoscopy
• Supraglottic Airway Device