Sellick Maneuver

Aspiration pneumonitis and pneumonia are significant complications associated with anesthetic management. Indeed, aspiration pneumonia was identified as the most important contributor to deaths among all pneumonia etiologies investigated. As many as 15% of all anesthesia malpractice claims in the United States are related to aspiration. Furthermore, it has been shown that aspiration was associated with the highest mortality rate of anesthesia-related reported airway difficulties in 1 study from the United Kingdom (UK) (n=133). It was the second most frequently reported airway complication, surpassed only by difficult intubation. Sellick proposed a method of esophageal compression to avoid aspiration of gastric contents in preparation for intubation. The eponymously named “Sellick Maneuver” is now commonly called cricoid pressure. This method has been widely adopted and thoroughly investigated following its introduction in 1961. Arguably, 1 of its most distinctive features is that it has become an integral part of rapid sequence intubation, pre-oxygenation, and short induction to intubation interval. Cricoid pressure has been shown to attenuate the incidence of aspiration mainly through posterior compression of the cricoid cartilage. The cricoid cartilage is a complex, ring-like structure inferior to the cricothyroid cartilage at level C6. Sellick documented that this compression occludes the esophagus at C5, whereas other studies, aided by advanced imaging technologies, have specified the post-cricoid hypopharynx as the likely target. The post-cricoid hypopharynx includes the cricopharyngeus as a component of the upper esophageal sphincter.