Cricoid pressure: indications and complications

Cricoid pressure to occlude the upper end of the oesophagus, also called the Sellick manoeuvre, may be used to decrease the risk of pulmonary aspiration of gastric contents during intubation for rapid induction of anaesthesia. Effective and safe use of the technique requires training and experience. Cricoid pressure is contraindicated in patients with suspected cricotracheal injury, active vomiting, or unstable cervical spine injuries. The technique may be particularly difficult in patients with a history of difficult intubation. The recommended pressure to prevent gastric reflux is between 30 and 40 Newtons (N, equivalent to 3-4 kg), but pressures greater than 20 N cause pain and retching in awake patients and a pressure of 40 N can distort the larynx and complicate intubation. The recommended procedure is, therefore, to induce anaesthesia and apply a pressure of about 30 N, either manually or with the cricoid yoke, to facilitate intubation. Reported complications of cricoid pressure during intubation include oesophageal rupture and exacerbation of unsuspected airway injuries.