What is cricoid pressure (Sellick maneuver) and why is its routine use controversial?

• A. Pressure applied to widen the airway; controversial due to causing hypoxemia.
• B. A measurement technique for airway pressure; controversial due to inaccuracy.
• C. Applied cricoid pressure to occlude the esophagus and reduce regurgitation; routine use is controversial due to potential airway compromise and evidence questioning its benefit.
• D. Pressure applied to the trachea to facilitate intubation; controversial due to causing airway damage.

Answer: (C)

Cricoid pressure, or the Sellick maneuver, involves pressing the cricoid cartilage backward to compress the esophagus against the spine in order to occlude it and reduce regurgitation during induction of anesthesia or rapid-sequence intubation. The idea is to prevent stomach contents from moving up the esophagus and being aspirated into the lungs while the airway is being secured. Routine use is controversial because, although it targets aspiration risk, it can compromise the airway by distorting anatomy, making laryngoscopy harder, and impairing ventilation if applied too forcefully or incorrectly. Additionally, the quality of evidence showing a clear reduction in aspiration with this maneuver is limited or mixed. As a result, many guidelines favor selective use and emphasize readiness to release pressure if ventilation or intubation becomes difficult, rather than applying it universally.