• Anesthesia and analgesia · Nov 2009

    Cricoid pressure results in compression of the postcricoid hypopharynx: the esophageal position is irrelevant.

    • Mark J Rice, Anthony A Mancuso, Charles Gibbs, Timothy E Morey, Nikolaus Gravenstein, and Lori A Deitte.
    • Departments of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida 32610-0254, USA. mrice@anest.ufl.ed
    • Anesth. Analg. 2009 Nov 1;109(5):1546-52.

    BackgroundSellick described cricoid pressure (CP) as pinching the esophagus between the cricoid ring and the cervical spine. A recent report noted that with the application of CP, the esophagus moved laterally more than 90% of the time, questioning the efficacy of this maneuver. We designed this study to accurately define the anatomy of the Sellick maneuver and to investigate its efficacy.MethodsTwenty-four nonsedated adult volunteers underwent neck magnetic resonance imaging with and without CP. Measurements were made of the postcricoid hypopharynx, airway compression, and lateral displacement of the cricoid ring during the application of CP. The relevant anatomy was reviewed.ResultsThe hypopharynx, not the esophagus, is what lies behind the cricoid ring and is compressed by CP. The distal hypopharynx, the portion of the alimentary canal at the cricoid level, was fixed with respect to the cricoid ring and not mobile. With CP, the mean anterioposterior diameter of the hypopharynx was reduced by 35% and the lumen likely obliterated, and this compression was maintained even when the cricoid ring was lateral to the vertebral body.ConclusionsThe location and movement of the esophagus is irrelevant to the efficiency of the Sellick's maneuver (CP) in regard to prevention of gastric regurgitation into the pharynx. The hypopharynx and cricoid ring move together as an anatomic unit. This relationship is essential to the efficacy and reliability of Sellick's maneuver. The magnetic resonance images show that compression of the alimentary tract occurs with midline and lateral displacement of the cricoid cartilage relative to the underlying vertebral body.

      Pubmed     Full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…