The Effect of Cricoid Pressure Application on Airway Patency

Comment The application of pressure to the cricoid cartilage has become routine practice for the prevention of gastric regurgitation since its introduction into clinical practice by Sellick in 1961. Despite its widespread use, the effect of cricoid pressure application on airway patency has not been previously fully assessed. The finding by Allman that the use of manual cricoid pressure causes a degree of airway obstruction and can on occasion produce complete airway occlusion is interesting and important. Moreover, the author speculates that the obstruction probably occurs at the level of the vocal cords, the narrowest part of the adult airway. He examined several subjects undergoing fiberoptic intubation and noted that in some individuals minimal pressure on the cricoid cartilage can distort laryngeal structures, producing vocal cord apposition. This study underscores the necessity of meticulous preoxygenation before rapid sequence induction. In the event of a failed intubation, there is a considerable chance that appropriate oxygenation may be difficult if not impossible as long as cricoid pressure is maintained.