Cricoid pressure: Teaching the recommended level

The Sellick maneuver or cricoid pressure is an effective means of preventing passive aspiration of gastric contents. Recent studies recommend a pressure of 20 newtons (N) when the patient is awake, increasing to 30-40 N with unconsciousness. This study was proposed to determine whether with education and practice, anesthesia providers and assistants could be taught a recommended cricoid pressure and retain this skill. Cricoid force was measured using a life-size laryngotracheal model on a calibrated infant scale. Fifty-three participants were divided into six groups: MD faculty; CA-1, 2, and 3 Residents; certified registered nurse anesthetists (CRNA); and Others. Each was asked to apply pressure to the blinded model to simulate application of the Sellick's maneuver to an ''awake'' and ''unconscious'' patient-on four occasions: before instruction of the recommended pressures (Preinstruction), after being informed of the recommended magnitudes of 20 N/awake and 30-40 N/anesthetized (Postinstruction), after a period of unblinded practice (Postpractice), and 3 mo or longer after practice (Follow-up). Initial attempts revealed inadequate force by all participants, ''awake'' and ''anesthetized.'' All participants were able to learn the recommended amount of applied pressure and were able to retain this knowledge after 3 mo. This model represents an easy and practical means of teaching the application of the optimal level of force to practitioners and assistants.