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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Therefore, it would be an alternative to the proposed periodical training in mechanical models, which is not practical. From the decade of on, studies on compression of the cricoid cartilage started focusing on the force that should be applied and not on gastric pressure.

Airway obstruction with cricoids pressure and lateral tilt. The technique involves the application of backward pressure on the cricoid cartilage with a force of newtons [4] to occlude the esophaguspreventing aspiration se gastric contents during induction of anesthesia and in resuscitation of emergency victims when intubation is delayed or not possible. It does not seem to be significant differences in the incidence of pulmonary aspiration when different sizes of nasogastric tube are used The technique involves the application of pressure gurp the cricoid cartilage at the neck, thus occluding the esophagus which passes directly behind it.

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To Do or Not Do”. The cricoid cartilage pressure maneuver requires knowledge of the anatomy of upper airways and the correct force to be used. Auditing the application of cricoid pressure.

However, two studies in cadavers demonstrated that the efficacy of the Sellick maneuver is not reduced with the presence of the nasogastric tube 19, Applying force on the anterior aspect of 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. Views Read Edit View history. Vanner RG – Mechanisms of regurgitation and its prevents with cricoid pressure.

J Emerg Trauma Shock. When the Sellick maneuver is not applied properly, it can hinder intubation and ventilation InFanning was the first author to study the intragastric pressure required to overcome the force generated by cricoid cartilage compression. Eur J Emerg Med, ; Brock-Utne JG – Is cricoid pressure necessary? The technique is vurp for adults and children, except by the reduced size and the more cephalad placement of the cricoid cartilage in younger patients 1. Can J Anaesth, ; As all techniques, cricoid pressure has indications, contraindications and side effects.


Placement of a nasogastric tube before anesthesia in high-risk patients for pulmonary aspiration, to drain liquid and gases present bjrp the stomach, is a common practice.

Some cartilaginous structures of the ed airways are “U”-shaped, which is the case of the thyroid cartilage and the trachea. Kopka A, Robinson D – The 50 ml syringe training aid should be itilized immediately before cricoid pressure application. It has been observed that the nasogastric tube does not interfere with the insertion of the laryngeal mask and that the mask does not prevent insertion of the tube. Some believe that cricoid manjobra in pediatric population, especially neonates, improves glottic view and aids tracheal intubation apart from its classical role in rapid sequence intubation for aspiration prophylaxis.

The study also evaluated the adequate force to be used according to those professionals. Since then, the maneuver has been widely accepted by anesthesiologists as a fundamental manibora during induction with the rapid sequence technique.

Compression of the cricoid cartilage: current aspects

Thus, during anesthetic induction, while the patient is awake, 10 to 20 N should be applied, and 30 to 40 N when the patient is unconscious Cricoid pressure may frequently be applied incorrectly. Vanner e Pryle 19 observed that 30 N equivalent to 3 kg was the necessary force that should be applied on the cricoid cartilage to prevent regurgitation of NS in 10 cadavers with esophageal pressure of up to 55 cmH 2 O. 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.

Rev Bras Anestesiol, ; The BURP maneuver, when used in combination with Sellick maneuver, can hinder visualization of the glottis. In some cases, visualization of the vocal cords is possible only after external manipulation of structures, such as the cricoid cartilage.


Cricoid pressure may also compress the glottis, which can obstruct the view of the laryngoscopist and actually cause a delay in securing the airway. 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 According to Kopka and Robinson 27the mL syringe is an effective training model, even when applied immediately before using the Sellick maneuver.

Besides, can cause deformity of the cricoid cartilage, closure of the vocal cords, and difficulty to ventilate if it is not used properly. When the difficult to manage airways is only noticed after general anesthesia induction, ventilation with a face mask would re recommended immediately, but one should be careful with the patient on a full stomach.

Semin Anesth Per Manionra Pain, ; Just feel the force According to the authors, cardiovascular changes were similar to those observed during tracheal maniovra in awake patients. The aspects that have motivated some authors to abandon the Sellick maneuver during anesthetic induction with the rapid sequence technique d also discussed.

Besides, when not used properly, it can cause deformity of the cartilage, closure of the vocal cords, and difficulty ventilating.

Int J Obst Anesth, ;2: Cricoid pressure should not be confused with the “BURP” Backwards Upwards Rightwards Pressure manoeuvre, which is used to improve the view of the glottis during laryngoscopy and tracheal intubationrather than to prevent regurgitation. A balloon to occlude the cardia and manlobra gastroesophageal reflux, associated with the nasogastric tube, has been successfully used. Despite the importance of the Sellick maneuver in preventing pulmonary aspiration, it does not guarantee protection of the airways in all patients, especially when not used properly.

The force applied should be enough to prevent aspiration, but not high enough to cause obstruction of the airways or esophageal rupture in case of vomiting

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