Brian Sellick

Biography

• Born on June 13, 1918 in Dorking, Surrey, England
• 1941 – Qualified in medicine from Middlesex Hospital
• WWII – Worked as a Junior resident anaesthetist in London; and Surgeon Lieutenant in the Royal Navy Volunteer reserve
• 1946 – Returned as honorary consultant anaesthetist staff at the Middlesex Hospital, London. Specialised in thoracic anaesthesia
• 1953 – Fellow of the Faculty of Anaesthetists. He worked for most of his career in the Middlesex Hospital with the exception of a short stint in Henry Swan’s clinic in Denver, Colorado in 1956 to observe the use of hypothermia. He introduced this technique back home after much experimentation and modification
• 1956 – Sellick published his paper in the Lancet on the use of hypothermia in cardiac surgery.
• 1961 – Lancet article on cricoid pressure
• 1962 – Elected the board of the Faculty of Anaesthetists, a position he held until 1978.
• 1972-1974 Council member of the Royal College of Surgeons
• 1992 – Henry Hickman Medal of the Royal Society of Medicine
• Retired in 1978
• Died on July 13, 1996

Medical Eponyms

Sellick manoeuvre (1961) Cricoid pressure

The regurgitation and possible inhalation of gastric contents before intubation had been a growing problem following the use of the short acting relaxant drugs to aid intubation. Using cadavers Sellick found that he could prevent the reflux of gastric contents into the pharynx during tracheal intubation by the application of cricoid pressure

When the contents of the stomach or oesophagus gain access to the air-passages during anaesthesia, the consequences are disastrous. In spite of modem anaesthetic techniques – or sometimes, regrettably, because of them – regurgitation is still a considerable hazard during the induction of anaesthesia, particularly for operative obstetrics and emergency general surgery.

Cricoid pressure must be exerted by an assistant. Before induction, the cricoid is palpated and lightly held between the thumb and second finger; as anaesthesia begins, pressure is exerted on the cricoid cartilage mainly by the index finger. Even a conscious patient can tolerate moderate pressure without discomfort but as soon as consciousness is lost, firm pressure can be applied without obstruction of the patient’s airway. Pressure is maintained until intubation and inflation of the cuff of the endotracheal tube is complete

Backward pressure of the cricoid cartilage against the cervical vertebrx can be used to occlude the oesophagus (a) to control regurgitation of stomach or oesophageal contents during induction of anaesthesia, or (b) to prevent gastric distension from positive-pressure ventilation applied by facepiece or mouth-to-mouth respiration. It is contraindicated during active vomiting.

Sellick 1961

Controversies

The principal and anatomical rationale for the Sellick Manoeuvre was first described by John Hunter in 1776 in his article ‘Proposals for the recovery of people apparently drowned’. Others working in the field referenced Hunters work such as Charles Kite (1768-1811) in his essay on the recovery of the apparently dead…and the subsequent description of the construction and uses of a portable apparatus for the recovery of the apparently dead

Sellick made no reference to these other works and it is unclear whether his own maneuver was inspired by the work of Hunter, Kite and the Royal Humane Society….

Major Publications

• Sellick BA. A method of hypothermia for open-heart surgery. Lancet 1957; 269(6966): 443–6.
• Sellick BA. Cricoid pressure to control regurgitation of stomach contents during induction of anaesthesia. Lancet. 1961; 2(7199): 404-6.

References

Biography

• Pallister WK. Obituary Brian Arthur Sellick. Anaesthesia, 1996; 51: 1194-1195
• Wilkinson DJ. Brian A. Sellick, M.B: Father of Cricoid Pressure Maneuver (1918-1996). American Society of Anesthesiologists (ASA) Newsletter. 1999, 63 (9).
• Baskett PJ, Baskett TF. Resuscitation great: Brian Sellick, cricoid pressure and the Sellick maneuver. Resuscitation. 2004; 61(1): 5-7

Eponymous terms

• Hunter J. Proposals for the recovery of people apparently drowned. Philosophical Transactions of the Royal Society 1776; 66: 412–25
• Kite C. An essay on the recovery of the apparently dead. London 1788
• Savigny JH. Description of the construction and uses of a portable apparatus for the recovery of the apparently dead: as recommended in an essay on the subject by Charles Kite. 1789
• Maltby JR. The Sellick Manoeuvre. In: Maltby JR, editor. Notable Names in Anaesthesia. London, RSM Press 2002; 196–8.
• Bhatia N, Bhagat H, Sen I. Cricoid pressure: Where do we stand? J Anaesthesiol Clin Pharmacol. 2014 Jan;30(1):3-6.
• Birenbaum A etal; IRIS Investigators Group. Effect of Cricoid Pressure Compared With a Sham Procedure in the Rapid Sequence Induction of Anesthesia: The IRIS Randomized Clinical Trial. JAMA Surg. 2019 Jan 1;154(1):9-17.
• Nickson C. Cricoid pressure. CCC
• Nickson C. Cricoid: To Press or Not to Press? RAGE
• Cadogan M. Portable apparatus for the recovery of the apparently dead. LITFL

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