![]() ![]() In other words, do it at your own risk and judgement because the evidence is weak.Īfter all these years, no study has provided convincing evidence that cricoid pressure is effective in preventing aspiration⁶. However, none of the guidelines adopts a firm policy to remove cricoid pressure completely. In 2015, the German society of Anaesthesia and Intensive Care revised its recommendation to omit cricoid pressure after weighing up the potential risks vs benefits⁵. Germany was one of the first countries to design national guidelines on airway management in 2004. If cricoid pressure is used it should be adjusted, relaxed or released if it impedes ventilation/intubation₄⁴. The European Resuscitation Council removed cricoid pressure as routine practice in RSI. Clinical practice guidelines from the Scandanavian Society of Anaesthesia and Intensive Care in 2010 no longer recommend cricoid pressure as mandatory but can be used with individual judgement³. The 2015 guidelines of management of unanticipated difficult intubation in adults from the Difficult Airway Society still recommend cricoid pressure as routine standard practice², but some professional associations are moving away from that in recent years. Many anaesthetists advocate the abandonment of cricoid pressure, but some are still holding on it, due to fear of aspiration in patient. This manoeuvre was even given its name after him – The Sellick manoeuvre.įast forward 6 decades since its introduction, the evidence-based recommendation to apply cricoid pressure to prevent gastric regurgitation and aspiration remained at level 4 (evidence based on case series) and Grade D recommendation (weak evidence and practice with caution). It was rapidly included as “standard of care” for rapid sequence induction (RSI). He published his findings in The Lancet, which subsequently received recognition worldwide. ![]() Three of his patients had regurgitation upon release of cricoid pressure. He later reported applying this technique in 26 high-risk patients, of which he found 23 patients did not report regurgitation before, during or after intubation. Sellick first demonstrated cricoid pressure in cadavers to prevent reflux of gastric content from reaching the pharynx in a small case series in 1960¹. “Are you pro or against cricoid pressure?” This was the exact question in a short debate among colleagues during our theatre tea break. ![]()
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