What is the role of the Sellick maneuver in rapid sequence intubation (RSI)?

Updated: Feb 28, 2019
  • Author: Keith A Lafferty, MD; Chief Editor: Guy W Soo Hoo, MD, MPH  more...
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Answer

There is a general lack of clinical evidence in several areas of RSI, including use of atropine as an adjunct agent for children, the role of lidocaine in pretreatment, the role of a "defasciculating" or priming dose of a nondepolarizing paralytic agent, relative contraindications for use of succinylcholine, and even the amount and methods of preoxygenation and the need to use cricoid pressure (Sellick maneuver). Use of the Sellick maneuver in preventing aspiration has never been proven, but it has been confirmed in increasing airway resistance and decreasing tidal volumes. Also, MRI studies have shown that the esophagus more consistently lies to the right of the trachea than posterior. This article highlights some of these controversies, and the interested reader can also review El-Orbany's 2010 article. [8]

This article focuses on direct laryngoscopy using a traditional direct laryngoscope.  VAL is discussed as well.


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