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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Anterior cricoid pressure was considered the standard of care during Rapid Sequence Intubation for many years. Cricoid pressure may frequently be applied incorrectly.
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. The proximal esophagus begins at the inferior portion of the cricoid cartilage.
Curr Opin Anaesthesiol, ; The technique is similar for adults and children, except by the reduced size and the more cephalad placement of the cricoid cartilage in younger patients 1. The necessary force to compress 10 mL of air when the tip of the syringe is closed is approximately 30 N The authors observed the volume of air compressed by the plunger and transformed the values observed in measures re force. Brock-Utne JG – Is cricoid pressure necessary?
Cricoid pressure – Wikipedia
When the Sellick maneuver is not applied properly, it can hinder intubation and ventilation The cricoid cartilage pressure maneuver requires knowledge of the anatomy of upper airways and the correct force to be used.
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.
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 Anaesth Intensive Care ; This association is a good option for the management of difficult airways in patients at risk for aspiration In his original work, Sellick 2 recommends removal of the tube before anesthesia induction.
According to the author: Cricoid pressure may displace the esophagusmake ventilation with a facemask or with an laryngeal mask airway LMA more difficult, interfere with LMA placement and advancement of a tracheal tube and alter laryngeal visualization by a flexible bronchoscope.
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But according to some studies, Sellick maneuver hinders proper positioning of both devices 38, Just feel the force Despite manionra 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. J Emerg Trauma Shock.
The study also evaluated the adequate force to be used according to those professionals. In his original work 2Sellick does not mention the force applied on the cricoid cartilage.
Cheney FW – Aspiration: However, other investigators have found that cricoid pressure does not increase the rate of manioobra intubation. 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.
Canadian Journal of Anesthesia.
Compression of the cricoid cartilage was initially described by Monro 1: Endoscopic and radiologic studies, as well as patients who developed pulmonary aspiration despite the use of Sellick maneuver, have raised doubts about the usefulness of this technique.
Knowledge and performance amongst anaesthetic assistants. Ann Intern Med, ; Acta Anaesthesiol Scand, Besides, knowledge of the force to be applied, acquired through training in mechanical models, decreased with time.
Sellick maneuver is not a risk-free procedure. Pressure should be applied on the cricoid cartilage to close the esophagus without interrupting passage of air through the larynx. 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 In some cases, visualization of the vocal cords is possible only after external manipulation of structures, such as the cricoid cartilage.
Eur J Anaesthesiol, ;