Ultrasonography guided modified Sellick manoeuvre in post-oesophagectomy patients – a case series*

Abstract

Oesophagectomy is an established treatment option for the management of oesophageal carcinoma. This procedure results in loss of the lower oesophageal sphincter, which increases the risk of pulmonary aspiration in patients presenting for subsequent surgeries. Consequently, innovative strategies are needed to enhance safety during airway management. Although Sellick manoeuvre (cricoid pressure) is commonly used to mitigate the risk of aspiration, there is limited evidence to support its efficacy. Additionally, cricoid pressure may not be effective in patients who have undergone oesophagectomy because of the altered neck anatomy. In this case series, we present seven post-oesophagectomy patients who underwent ultrasound-guided modified Sellick manoeuvre for airway management. During tracheal intubation with a videolaryngoscope, the gastric conduit in the neck was visualised and compressed with the ultrasound probe, attempting to oppose both walls of the conduit and reduce the risk of regurgitation. This approach addresses the challenges posed by altered anatomy and the limitations of traditional cricoid pressure, potentially enhancing the safety of airway management in these patients. While ultrasound-guided oesophageal compression shows promise as a feasible technique, further studies are needed to validate its effectiveness.