Correspondence  |   July 2003
Cricoid Pressure Is Effective in Preventing Esophageal Regurgitation
Author Notes
  • David Geffen School of Medicine at University of California, Los Angeles.
Article Information
Correspondence   |   July 2003
Cricoid Pressure Is Effective in Preventing Esophageal Regurgitation
Anesthesiology 7 2003, Vol.99, 242. doi:
Anesthesiology 7 2003, Vol.99, 242. doi:
To the Editor:—
Cricoid pressure (Sellick's maneuver) is a routinely used technique for the prevention of pulmonary aspiration of gastric contents during anesthesia in patients at high risk of aspiration. Its effectiveness in preventing regurgitation of esophageal contents has been demonstrated in several studies 1,2 and in cadavers. 3–5 However, its effectiveness in preventing aspiration in clinical practice is debated. 6 The following case scenario clearly demonstrates its effectiveness during clinical anesthesia.
A 21-yr-old, 75-kg man presented for repositioning of an intraocular lens under general anesthesia. He had a history of esophageal reconstruction by gastric pull-through to treat childhood achalasia. General anesthesia about 2 yr earlier for eye surgery had resulted in pulmonary aspiration of gastric contents during induction of anesthesia. No further details were available. Preoperatively, he was apprehensive about recurrent aspiration. On the day of surgery, he was given metoclopramide 10 mg and ranitidine 20 mg intravenously; he had taken nothing by mouth for 15 h previously. In the operating room, he was positioned supine with extension of the neck. The cricoid cartilage was identified while the patient was awake. Following adequate preoxygenation, continuous cricoid pressure was applied immediately before the induction of anesthesia with propofol 200 mg and succinylcholine 120 mg in a rapid sequence manner. Laryngoscopy and tracheal intubation with a 7.5 endotracheal tube were easily accomplished, the endotracheal tube cuff was inflated with 10 ml of air, and cricoid pressure was released. This was followed immediately by the appearance of copious, greenish fluid in the mouth, which was suctioned. There were no further sequelae.
Although no prospective randomized controlled clinical studies can be done to prove its clinical efficacy, the above case illustrates that proper application of cricoid pressure is effective, at least in some patients, in the prevention of gastric aspiration from passive regurgitation.
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