Hi All,

New to the list. Question: How many different techniques are there to apply cricoid pressure?

We all learned and used the traditional Sellick technique. I had a colleague get in a rather heated debate about "other" techniques for applying cricoid pressure. Getting ready to intubate a morbidly obese, large breasted full stomach patient, she wanted the assistant to lay their hand flat on the chest (fingers pointing caudaly) and using the first, second and third fingers, to press on the cricoid cartilage. The MDA vehemently objected and the two exchanged words. Unfortunately she is now being reported (there was enough blame here on both sides) mainly because this exchange took place in front of an awake patient.

Anyway, the need here is to find anyone who has used, been taught or knows of alternate "techniques" of applying cricoid pressure. Any references or papers, etc. would be gladly accepted. Need this info ASAP. You can answer on this list or better...reply to [email protected].

Thanks to all who can reply for your efforts and time.

Bob McKane, CRNA

Hi bob, check out http://www.theairwaysite.com they may have a link to email an expert. i attended a workshop with this well known, reputable group and i never heard that technique come up. The conference was actually on 'the difficult airway'.

i will ask a few of the anesthestists at work too.

Thanks East Coast,

I work in Lancaster County, Pa. Appreciate any help.

Bob

it is impossible to apply the required force on the cricoid with your fingers/palm splayed out in that way - especially in a fat patient, it would become even more difficult.... The Sellick maneuver calls for 44 Newtons, 9-10 pounds of pressure which requires upper arm and upper body exertion, not forearm pressure as applied by your colleague...

in fact, it has been shown numerous times that no cricoid pressure is often better than bad cricoid pressure... :)

How mush is 44 newtons? hers how you can tell. press your thumb and index finger against your nose until it hurts. and this about 44 newtons.

are you doing it. ha ha ha ha it worked.

but no. really thats true. try it. are you doing it. rofl

yeah baby

Originally posted by ezsleep

Hi All,

New to the list. Question: How many different techniques are there to apply cricoid pressure?

We all learned and used the traditional Sellick technique. I had a colleague get in a rather heated debate about "other" techniques for applying cricoid pressure. Getting ready to intubate a morbidly obese, large breasted full stomach patient, she wanted the assistant to lay their hand flat on the chest (fingers pointing caudaly) and using the first, second and third fingers, to press on the cricoid cartilage. Bob McKane, CRNA

As an O.R. nurse, I, too, learned and use the Sellick technique, and so does every other RN, CRNA, and anesthesiologist I have worked with at various facilities over 25 years--WITH THE EXCEPTION OF ONE--an anesthesiologist--who used the "other"technique you have just described, and would not allow the RNs to do cricoid because "our way" was not "his way."

Wonder if they are one and the same guy!!!

Good point Tenesama. If I understand the questionable technique correctly, I think I would have a lot of trouble applying the correct amount of pressure in this manner.

We had a morbidly obese pt the other day. Anesthesia nasally intubated him. I don't think I've ever seen anyone attempt it the way they did it. The pt was very lethargic, so the anesthetist began to stick the tube down into his nose. As the pt woke up, the MD simply talked in a soothing tone to the pt. When that didn't work, me and another anesthetist held his arms down with a mod amt of force, but the one inserting the nasal tube kept working it in, using a real soft tone. Finally, he got it, but it was a bit nerve wracking.

What I want to know is why they didn't use any sedation. Is it because they didn't want to knock him out and make a relatively stable situation less stable?

if he had received sedation then you might have lost his airway - keeping him awake you can make sure that he maintains his airway for you until you secure it... safest way

Originally posted by Diprivan/Vented

We had a morbidly obese pt the other day. Anesthesia nasally intubated him. I don't think I've ever seen anyone attempt it the way they did it. The pt was very lethargic, so the anesthetist began to stick the tube down into his nose. As the pt woke up, the MD simply talked in a soothing tone to the pt. When that didn't work, me and another anesthetist held his arms down with a mod amt of force, but the one inserting the nasal tube kept working it in, using a real soft tone. Finally, he got it, but it was a bit nerve wracking.

What I want to know is why they didn't use any sedation. Is it because they didn't want to knock him out and make a relatively stable situation less stable?

I think every morbidly obese patient should receive awake FIBEROPTIC nasal intubation. Most I have seen have it done with Cocaine applied topically to nares. Smooth as silk. Patients very cooperative and I think feel as if they are enabled to participate in their own care.

Shouldn't every morbidly obese patient undergoing GETA also have full stomach precautions--most importantly, cricoid pressure? Seems like more and more I am seeing people intubate without cricoid in these cases--is there new research out there that says it isn't necessary, or are those doing it this way being needlessly careless?

Now, here's a question: How many still give a corticosteroid (usually IV decadron) for traumatic or prolonged intubations? Seems like we always did it routinely in the '80s and "90s, now I am seeing more people say that the researcch they have read say it makes no difference (although, if the case belongs to an ENT doc, it is still done routinely In fact, some of them have WRITTEN articles espousing the virtues of decadron to reduce laryngeal edema.)