Sellick maneuver assisted real-time to achieve target force range in simulated environment—A prospective observational cross-sectional study on manikin

Abstract

A force sensor system was developed to give real-time visual feedback on a range of force. In a prospective observational cross-section study, twenty-two anaesthesia nurses applied cricoid pressure at a target range of 30-40 Newtons for 60 seconds in three sequential steps on manikin: Group A (step 1 blinded, no sensor), Group B (step 2 blinded sensor), Group C (step 3 sensor feedback). A weighing scale was placed below the manikin. This procedure was repeated once again at least 1 week apart. The feedback system used 3 different colours to indicate the force range achieved as below target, achieve target, above target. Significantly higher proportion of target cricoid pressure was achieved with the use of sensor feedback in Group C; 85.9% (95%CI: 82.7%-88.7%) compared to when blinded from sensor in Group B; 31.3% (95%CI: 27.4-35.4%). Cricoid force achieved blind (Group B) exceeded force achieved with feedback (Group C) by a mean of 8.0 (95%CI: 5.9-10.2, p<0.0001) and 6.2 (95%CI:4.1-8.3, p< 0.0001) Newtons in round 1 and 2 respectively. Weighing scale read lower than corresponding force sensor by a mean of 8.4 Newtons (95% CI: 7.1-9.7, p<0.0001) in group B and 5.8 Newtons (95% CI: 4.5-7.1, p<0.0001) in Group C. Force sensor visual feedback system enabled application of reproducible target cricoid pressure with less variability and has potential value in clinical use. Using weighing scale to quantify and train cricoid pressure requires a review. Understanding the force applied is the first step to make cricoid pressure a safe procedure.

Effectiveness of the Sellick maneuver for painless gastroscopy in patients with esophageal hiatal hernia: A randomized, self‑control trial

“…First, the gastroscopy was performed from the upper esophagus without the Sellick maneuver, after which the anesthesiologist performed the Sellick maneuver, which involved the application of 30 Newton pressure to the cricoid cartilage ( 6 , 7 ), after which the gastroscopist performed the gastroscopy again. Patients were monitored until the end of the gastroscopy operation and the patient woke up in the postanesthesia care unit (PACU).…”

Effectiveness of the Sellick maneuver for painless gastroscopy in patients with esophageal hiatal hernia: a Randomized, self-control trial

“…A patient was formally included in this study if the gastrointestinal endoscopist proposed to diagnose a hiatal hernia in the esophagus during painless gastroscopy. First, the gastroscopy is performed from the upper esophagus without the Sellick maneuver, after which the anesthesiologist performs the Sellick maneuver, which involves the application of 30 Newton pressure to the cricoid cartilage [5,6], and the gastroscopist performs the gastroscopy again. After the operation, the patient was sent to the anesthesia recovery room until awakening.…”

The Cricoid Pressure Imperative: Incorporating Innovative Technology to Quantify Force

“…Such a capacitive-based sensor comprising a metal-incorporated silicon-based polyimide substrate for measuring CP has been developed, and the preliminary results in mannequins appear encouraging. 17,18 Mannequin Versus Human Subjects A CP monitoring device must not only be a standalone mannequin-based trainer but also be usable in actual patients in clinical settings. Despite significant advances in mannequin designs, the elastomeric properties of mannequins are still considerably different from those of human skin and soft tissue.…”

“…In terms of transducer technology, the system comprising a capacitance-based microelectromechanical force sensor array reported by Xue et al appears to be close to that required in an ideal device. 18 Since this device was recently tested in mannequins, 17 it needs to go through the cycle of human volunteer study followed by clinical trials before use in clinical practice. Alternatively, the CP training mannequin system developed by Connor et al used multiple thin-film force-sensitive resistors.…”

“…Such a capacitive-based sensor comprising a metal-incorporated silicon-based polyimide substrate for measuring CP has been developed, and the preliminary results in mannequins appear encouraging. 17,18…”