To the Editor:--The letter to the Editor by Kron questioned the validity of the statement by Schwartz et al. that cricoid pressure (the Sellick maneuver ) "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, 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." .
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