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Comment & Response
February 27, 2019

Utility of Cricoid Pressure

Author Affiliations
  • 1Department of Anesthesiology, Detroit Medical Center, Wayne State University, Detroit, Michigan
JAMA Surg. 2019;154(6):561-562. doi:10.1001/jamasurg.2018.5846

To the Editor As in William Shakespeare’s iconic quote, “To be, or not to be,” controversies surrounding the use of cricoid pressure, most recently revisited by Birenbaum et al,1 do not seem to die down. I want to raise 2 points.

First, even though the study by Rice et al2 was referenced in their text, they continually indicated that cricoid pressure is presumed to work by occluding the esophagus. Even though Rice et al2 had radiologically quantified the anatomy of cricoid pressure by magnetic resonance imaging almost a decade ago and clearly documented the postcricoid hypopharynx—and not the esophagus—being occluded during cricoid pressure, Birenbaum et al1 continued to misinterpret the mobile esophagus as the reason for failure of cricoid pressure when the transfixed postcricoid hypopharynx had been shown to provide occlusive apposition, not only by the medially located bony surface of cervical vertebrae but also by the laterally located muscular surface of longus colli.

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