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PATIENT SAFETY

Cricoid Pressure Results in Compression of the Postcricoid Hypopharynx: The Esophageal Position Is Irrelevant

Mark J. Rice, MD^*, Anthony A. Mancuso, MD, Charles Gibbs, MD^*, Timothy E. Morey, MD^*, Nikolaus Gravenstein, MD^*, and Lori A. Deitte, MD

From the Departments of *Anesthesiology, and Radiology, University of Florida College of Medicine, Gainesville, Florida.

Address correspondence and reprint requests to Mark J. Rice, MD, Department of Anesthesiology, University of Florida College of Medicine, PO Box 100254, JHMHSC, Gainesville, FL 32610-0254. Address e-mail to mrice{at}anest.ufl.edu.

Abstract

BACKGROUND: Sellick 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.

METHODS: Twenty-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.

RESULTS: The 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.

CONCLUSIONS: The 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.

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