MRI explains neck procedure

Thursday October 22nd, 2009

A long-standing anaesthetic technique, developed nearly 50 years ago in Britain, has been given scientific backing - thanks to MRI scanning.

Sellick's manoeuvre has been under challenge recently - with researchers questioning what evidence there is for it.

The technique involves pressing fingers against the patient's throat with the aim of preventing regurgitation of stomach contents into the airways while anaesthesia is being administered.

It was described in 1961 by a Briton, Dr Brian Sellick.

Now researchers at the University of Florida, USA, have used MRI to establish ow the manoeuvre works.

The technique is said to involve pinching the oesophagus between the cricoid and the neck vertebrae - and first came under challenge in 2003 when a study found that in most cases the oesophagus simply moved to the side during the procedure.

But the new study says the problem is that Dr Sellick did not fully understand the anatomy he was manipulating.

According to Dr Mark Rice, the procedure actually involves the hypopharynx, which is above the oesophagus. He is to report his findings in the journal Anesthesia & Analgesia.

Dr Rice said: "This is a major error that's been in the literature for 50 years. It turns out it doesn't matter (if the oesophagus moves)."

Professor Scott Springman, of the University of Wisconsin-Madison, said: "Because of Dr. Rice's study, Sellick's manoeuvre has again been shown to have anatomic efficacy, despite it occurring in a way that is different from the classic description.

"It also shows us that previous assumptions are not always correct, and that new technology can help us refine our hypotheses."

Anesthesia & Analgesia November 2009

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