Rapid sequence induction (RSI) is indicated for a patient with a full stomach. The sequence includes pre-oxygenation, cricoid pressure (Sellick manoeuvre), induction agent, and succinylcholine. The purpose of cricoid pressure is to:

• A Improve laryngoscopic view by displacing the larynx posteriorly
• B Reduce the dose of induction agent required
• C Prevent passive regurgitation by occluding the oesophagus against the cervical vertebra ✓
• D Prevent laryngospasm during intubation

Explanation

Sellick's manoeuvre applies backward pressure over the cricoid cartilage, which, unlike other laryngeal cartilages, is a complete ring; this compresses the oesophagus between the cartilage and the cervical vertebral body, preventing passive regurgitation of gastric contents into the pharynx before the cuff is inflated. The pressure should be approximately 30 N (3 kg force) once the patient is unconscious. It may also improve the glottic view if used together with backward-upward-rightward pressure (BURP), but this is a different manoeuvre. Cricoid pressure does not prevent active vomiting.

Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.