Cricoid Pressure Displaces the Esophagus: An Observational Study Using Magnetic Resonance Imaging

  title={Cricoid Pressure Displaces the Esophagus: An Observational Study Using Magnetic Resonance Imaging},
  author={Kevin J. Smith and Julian Dobranowski and Gordon Yip and Alezandre Dauphin and Peter T.-L. Choi},
Background Cricoid pressure (CP) is often used during general anesthesia induction to prevent passive regurgitation of gastric contents. The authors used magnetic resonance imaging to determine the anatomic relationship between the esophagus and the cricoid cartilage (“cricoid”) with and without CP. Methods Magnetic resonance images of the necks of 22 healthy volunteers were reviewed with and without CP. Esophageal and airway dimensions, distance between the midline of the vertebral body and… 

Cricoid cartilage and esophagus: CT scan study of the dynamic variability of their relative positions

It can be seen that the E is clearly displaced with regard to the CC, that this displacement is favored by extension, and the extension position of the head produces more displacement of the E but should preserve the containment of the cricoid pressure if the authors consider the thickness of theE wall.

Using Ultrasonography to Assess the Effectiveness of Cricoid Pressure on Esophageal Compression.

Alignment of Cricoid Cartilage and Esophagus and Its Potential Influence on the Effectiveness of Sellick Maneuver in Children

This is the first pediatric study on the rate and degree of esophageal displacement from the airway at the level of the cricoid cartilage andateral displacement occurred at a significantly greater rate in the younger children compared with the older children.

Cricoid Pressure Results in Compression of the Postcricoid Hypopharynx: The Esophageal Position Is Irrelevant

The location and movement of the esophagus is irrelevant to the efficiency of the Sellick’s maneuver (CP) in regard to prevention of gastric regurgitation into the pharynx and compression of the alimentary tract occurs with midline and lateral displacement of the cricoid cartilage relative to the underlying vertebral body.

The Effectiveness of Cricoid Pressure for Occluding the Esophageal Entrance in Anesthetized and Paralyzed Patients: An Experimental and Observational Glidescope Study

The current study provides additional visual and mechanical evidence supporting a success rate of at least 95% by using a cricoid force of 30 N to occlude the esophageal entrance in anesthetized and paralyzed normal adult patients.

Ultrasound Assessment of the Effectiveness of Cricoid Pressure

Application of cricoid pressure during rapid sequence induction to prevent regurgitation of gastric contents shows that CP is useful and effective in occluding the oesophagus even when it is located away from the mid-line and displaced with CP.

What About Compressing the Oesophagus with an Ultrasound Probe for a Modified Sellick Maneuver?

Palaryngeal pressure with an ultrasound probe has the potential to occlude the oesophagus and may be effective in all patient groups, and weak correlation was found between diameter change percentage and neck circumference.


Backward pressure of the cricoid cartilage against the cervical vertebrae can be used to occlude the oesophagus, to control regurgitation of stomach or oesphageal contents during induction of anaesthesia, or to prevent gastric distension from positive-pressure ventilation applied by facepiece or mouth-to-mouth respiration.

Ultrasound evaluation of cricoid pressure vs. ‘paralaryngeal pressure’ – a reply

References 1. Andruszkiewicz P, Wojtczak J, Wroblewski L, Kaczor M, Sobczyk D, Kowalik I. Ultrasound evaluation of the impact of cricoid pressure versus novel ‘paralaryngeal pressure’ on



The cricoid cartilage and the esophagus are not aligned in close to half of adult patients

There is a 49% frequency of some degree of lateral displacement of the esophagus relative to the cricoid cartilage (“cricoid”) using computed tomography images of normal necks.

Postcricoid region and cervical esophagus: normal appearance at CT and MR imaging.

Knowing of the normal appearance and variations of the postcricoid region and cervical esophagus is essential in detecting abnormalities in these areas.

Cricoid Pressure: Teaching the Recommended Level

This model represents an easy and practical means of teaching the application of the optimal level of force to practitioners and assistants and was proposed to determine whether with education and practice, anesthesia providers and assistants could be taught a recommended cricoid pressure.

Nasogastric tubes and cricoid pressure

In all cases of bloody tap which the authors have so far examined there has also been a large haematoma within the superficial fascial spaces of the spine, and similar, but smaller, haem atomas were also present in two of three patients following uncomplicated epidural.

Linear measurements in 2-dimensional pelvic floor imaging: the impact of slice tilt angles on measurement reproducibility.

Identical measurements made on radiologic images can vary widely and slice acquisition must be standardized to avoid errors in data comparison.

The application of cricoid pressure. An assessment and a survey of its practice.

Ananesthetists and paramedical personnel familiar with Sellick's manoeuvre were tested yielding results which indicate an unacceptably wide variation in performance in each group.

Cricoid pressure: knowledge and performance amongst anaesthetic assistants

Performance, as assessed by the variability of forces applied and proportion of subjects applying force within the authors' target range, was improved markedly by providing simple instruction about the required force in an understandable form and practical training in the application of a target force on a simulator.

If nothing goes wrong, is everything all right? Interpreting zero numerators.

The occurrence of "no events" seems to be viewed as very different both quantitatively and qualitatively from the occurrence of one or more events, so it is useful to look into some of the statistical and psychological issues that influence the occurrence.

Clinically Oriented Anatomy, 4th Edition