CRICOID PRESSURE - TEACHING THE RECOMMENDED LEVEL

The Sellick maneuver or cricoid pressure is an effective means of prev enting passive aspiration of gastric contents. Recent studies recommen d a pressure of 20 newtons (N) when the patient is awake, increasing t o 30-40 N with unconsciousness. This study was proposed to determine w hether with education and practice, anesthesia providers and assistant s could be taught a recommended cricoid pressure and retain this skill . Cricoid force was measured using a life-size laryngotracheal model o n a calibrated infant scale. Fifty-three participants were divided int o six groups: MD faculty; CA-1, 2, and 3 Residents; certified register ed nurse anesthetists (CRNA); and Others. Each was asked to apply pres sure to the blinded model to simulate application of the Sellick's man euver to an ''awake'' and ''unconscious'' patient-on four occasions: b efore 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). Initia l attempts revealed inadequate force by all participants, ''awake'' an d ''anesthetized.'' All participants were able to learn the recommende d amount of applied pressure and were able to retain this knowledge af ter 3 mo. This model represents an easy and practical means of teachin g the application of the optimal level of force to practitioners and a ssistants.