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Anesthesiology:
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Efficacy and Safety of Cricoid Pressure Needs Scientific Validation

Jackson, Stephen H. MD

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To the Editor:‐‐The letter to the Editor by Kron [1] questioned the validity of the statement by Schwartz et al. [2] that cricoid pressure (the Sellick maneuver [3]) "may have decreased the incidence" of aspiration as a complication of tracheal intubation in critically ill adults. Kron objected to "mandating a clinically unproved technique as standard of care." Although no such "mandate" appeared in Schwartz et al.'s article, Schwartz and Cohen, in their reply, [4] stated that "the use of cricoid pressure to protect the airway in patients at risk for aspiration during the induction of anesthesia and intubation of the trachea is and should remain the standard of care." The cited substantiation [3,5–7] for this dictum appears in their original paper and, albeit venerable, is less than scientifically overwhelming. Furthermore, there is no scientific validation for the commonly held belief that "improper application of cricoid pressure might explain any failures" to prevent aspiration." [4].
In conclusion, I urge a scientific reevaluation of the efficacy and safety of the traditional techniques employed for the patient at risk for aspiration during tracheal intubation.
Stephen H. Jackson, MD, Anesthesiologist, Good Samaritan Hospital, 2425 Samaritan Drive, San Jose, California 95124
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REFERENCES

1. Kron SS: Questionable effectiveness of cricoid pressure in preventing aspiration. ANESTHESIOLOGY 1995; 83:431.

2. Schwartz DE, Matthay MA, Cohen NH: Death and other complications of emergency airway management in critically ill adults. ANESTHESIOLOGY 1995; 82:367-76.

3. Sellick BA: Cricoid pressure to control regurgitation of stomach contents during induction of anaesthesia. Lancet 1961; 2:404-6.

4. Schwartz DE, Cohen NH: In reply to Kron. *RF 1* ANESTHESIOLOGY 1995; 83:432.

5. Fanning GI: The efficacy of cricoid pressure in preventing regurgitation of gastric contents. ANESTHESIOLOGY 1970; 32:553-5.

6. Salem MR, Wong AY, Mani M, Sellick BA: Efficacy of cricoid pressure in preventing gastric inflation during bag-mask ventilation in pediatric patients. ANESTHESIOLOGY 1974; 40:96-8.

7. Salem MR, Joseph NJ, Heyman HJ, Belani B, Paulissian R, Ferrara TP: Cricoid compression is effective in obliterating the esophageal lumen in the presence of a nasogastric tube. ANESTHESIOLOGY 1985; 63:443-6.

© 1996 American Society of Anesthesiologists, Inc.

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