Expert: Dr Ian Jackson - please note UK based - 7/24/2008

Question
Hello,
I've been an OR nurse for several years. Recently an anesthesiologist resident asked me to apply cricoid pressure while the patient was still awake, telling him that he will feel me doing this to his throat area. I have never been asked to apply the Sellick maneuver while the patient was awake before, only after he/she has just lost consciousness. Is this a new way to apply the procedure?

Also, I find it difficult to remove the stylet with just one hand while still applying the cricoid pressure. Does anyone else have this problem? Thank you.

Answer
Hi Suzanne
It sounds like your young doctor is a bit unsure of himself and is trying to 'do the right thing'. There is no evidence to suggest that the pressure needs to be applied prior to induction of anaesthesia - indeed the norm is as you say to apply it as the patient loses consciousness. However as long as you explain what is happening to the patient there is no reason not to apply the pressure prior to anaesthesia.
Now the stylet bit is a bit difficult sometimes - not enough hands!
Not much I can offer for that except that I try and make it as easy as possible for my assistant to pull it out. It is down to teamwork and the anaesthetist has to realise he is dependent on working together with you on that bit!
Kind regards
Dr Ian Jackson