Sellick Maneuver Definition, Steps, Intubation, Uses

Cricoid pressure, commonly referred to as the Sellick maneuver, is a method used during endotracheal intubation to attempt to lower the risk of regurgitation. The procedure involves applying pressure on the cricoid cartilage in the neck, which obstructs the passage of the esophagus, which runs right behind the cricoid cartilage. Cricoid pressure (CP), first described by Sellick in 1961, was applied during rapid sequence induction in order to "limit regurgitation of esophageal or gastrointestinal contents until insertion with a cuffed endotracheal tube was finished" and minimize the danger of aspiration of gastric contents. 

In addition, this technique, which is also known as Rapid Sequence Induction Intubation (RSII) in certain settings, is an essential component of emergency airway management plans. Cricoid pressure is a method that has become a standard component of rapid sequence intubation. Its primary purpose is to prevent the aspiration of gastric contents. The practice is still advised in some populations despite the scant evidence for its efficacy.

Sellick Maneuver Definition

The Sellick maneuver, also known as cricoid pressure, is a technique that is typically carried out in the course of rapid sequence intubation as a preventative measure against pulmonary aspiration. In this method, pressure is applied on the cricoid cartilage in order to either stop regurgitation or make the vocal cords more comfortable to see during tracheal intubation in an unconscious patient. Both of these goals are accomplished simultaneously.

Sellick Maneuver Steps

A cricoid pressure is applied to the trachea by an assistant, who places their thumb on one side of the trachea and their index and middle fingers on the other side. This pressure is applied prior to the induction of anesthesia, and the assistant does not remove it until after the cuff of the endotracheal tube has been inflated. The procedure should be described to the patient, and the helper should be instructed on how to apply the CP correctly.

Sellick Maneuver Intubation

To conduct the Sellick Maneuver, apply light pressure behind the cricoid cartilage on the front of the neck in a backward manner. This is done at the level of the anterior neck. During endotracheal intubation, the most common application of the maneuver is to assist in the proper alignment of the airway structures. The true benefit of this method is frequently misunderstood, and hence, it is frequently underutilized. During ventilation in an unprotected airway, the Sellick Maneuver can be useful because it offers a mechanism to prevent stomach insufflation and vomiting. This is the maneuver's primary benefit. BLS and ALS medical personnel can instruct a member of the CPR team to do this maneuver immediately and continuously until an endotracheal tube has been correctly inserted. The appropriate application of this technique can reduce the occurrence of aspiration pneumonitis, which has a high fatality rate.

Sellick Maneuver Uses

Despite the fact that there is little convincing data to back up this practice, cricoid pressure is often employed during rapid sequence induction in several nations for nearly 50 years.

The initial study that was written by Sellick was established on a limited sample size and was written during a time when large tidal volumes, head-down posture, and barbiturate anesthesia were the standard practices.

The approach is crucial for potentially avoiding gas insufflation into the stomach. Paralyzed patients in which stomach insufflation happens at lower inflation pressures experience an additional advantage from cricoid pressure.