La maniobra de Sellick o presión cricoidea es un procedimiento que se . D.D. Snider, D. Clarke, B.T. FinucaneThe “BURP” maneuver worsens the glotic view. Emergencias_9_6_pdf. VENTAJAS DE LA MANIOBRA BURP FRENTE A LA MANIOBRA DE SELLICK EN LA INTUACIÓN DIFÍCIL. 53 KB. Estudio sobre la eficacia clínica de la maniobra B.U.R.P. en la intubación orotraqueal (IOT) bajo laringoscopia directa (LD). Grijalba LA, Alcibar JL, Calvo López.

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Compression of the cricoid cartilage: current aspects

The force applied on the cricoid cartilage should be enough to occlude the esophagus, without obstructing or hindering ventilation. Assessing the force generated with the application of cricoid pressure. All bhrp contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License.

Learning to apply effective cricoid pressure using a part task trainer.

On the original study of Sellick 226 patients deemed to be at risk for pulmonary aspiration of gastric contents were evaluated. The cricoid cartilage pressure maneuver requires knowledge of the anatomy of upper airways and the correct force to be used.

Cricoid pressure

Curr Opin Anaesthesiol, ; The BURP maneuver, when used in combination with Sellick maneuver, bugp hinder visualization of the glottis. The incorrect use of the maneuver can cause deformity of the cartilage, closure of the vocal cords, and difficulty to ventilate, especially in women. The BURP maneuver backward, upward, rightward pressure on manipbra thyroid cartilage has been considered an interesting option in those cases 33but it should not be mistaken for the maneuver described by Sellick 2.

The objective of the present report was to discuss the indications, technique, complications, and reasons why some authors have contested the indication of this maneuver. If visualization of the vocal cords with laryngoscopy or ventilation brup a face mask is not adequate, one should reduce the force applied and reevaluate the place where pressure is being applied. The effects on brochoscopy of applying pressure on the cricoid cartilage were evaluated by different authors, with conflicting results According to Kopka and Robinson 27the mL syringe is an effective training model, even when applied immediately before using the Sellick maneuver.


Besides, a considerable mniobra of individuals identified the thyroid cartilage as the structure to be compressed.

Cricoid pressure – Wikipedia

Endoscopic and radiological studies, as well as patients who presented pulmonary aspiration, despite the use of the Sellick maneuver, have raised doubts on the usefulness of the technique.

Brock-Utne JG – Is cricoid pressure necessary? Applying pressure on the cricoid cartilage increases the tonus of the upper esophageal sphincter 14but decreases the tonus of the lower esophageal sphincter 15suggesting the presence of mechanoreceptors in the pharynx that promote relaxation of this sphincter.

InSellick described the importance of applying pressure on the cricoid cartilage to prevent regurgitation of gastric contents during induction of anesthesia. Cricoid force greater than 40 N can compromise airway patency and make tracheal intubation difficult. According to the Single Hand technique, the thumb and the middle finger are placed on each side of the cricoid cartilage and the index finger is placed above.

However, the so-called “olfactory position” flexion of the neck associated with hyperextension of the atlanto-occipital joint is currently deemed more adequate for ventilation and tracheal intubation Cricoid pressure may frequently be applied incorrectly. Anterior cricoid pressure was considered the standard of care during Rapid Byrp Intubation for many years.

This association is a good option for the management of difficult airways in patients at risk for aspiration Anaesth Intensive Care brp Vanner RG – Mechanisms of regurgitation and its prevents with cricoid pressure. When the difficult to manage airways is only noticed after general anesthesia induction, ventilation with a face mask would be recommended immediately, but one should be careful with the patient on a full stomach.

In his original work 2Sellick does not mention the force applied on the cricoid cartilage. Therefore, it would be an alternative to the proposed periodical training in mechanical models, which is not practical. The necessary force to compress 10 mL of air when the manibora of the syringe is closed is approximately 30 N Sellick BA – Cricoid pressure to control regurgitation of stomach contents during induction of anesthesia. Flexion of the head induced by the force applied indirectly on the cervical spine, decreasing visualization of the glottis, is one of the disadvantages of this maneuver 9.


Applying force on the anterior aspect manionra the cricoid cartilage causes compression of the esophagus against the spine between the fifth and sixth cervical vertebrae C 5 and C 6as long as those structures are aligned in the axial plane. Rev Bras Anestesiol, maniobraa Some believe that cricoid pressure in pediatric population, especially neonates, improves glottic view and aids tracheal intubation apart from its classical role in rapid sequence intubation for aspiration prophylaxis.

But according to some studies, Sellick maneuver hinders proper positioning of both devices 38, Int J Obst Anesth, ;2: Priebe HJ – Cricoid pressure: J Emerg Trauma Shock. According to the author: Placement of a nasogastric tube before anesthesia in high-risk patients for mabiobra aspiration, to drain liquid and gases present in the stomach, is a common practice. Can J Anaesth, ; Sellick described the importance of applying pressure in the cricoid cartilage during anesthesia induction to prevent regurgitation of gastric contents.

Burrp technique is also important in possibly preventing insufflation of gas into the stomach. In those cases, the temporary interruption of the maneuver might be necessary, which seems to be reasonable since compression of the cricoid cartilage can become ineffective after being applied for a few minutes Wilson NP – No pressure!

This tube with a gastric balloon has been studied in conjunction with the laryngeal mask. Canadian Journal of Anesthesia, 49 5 ,