The closed claims analysis of cases of pulmonary aspiration of gastric content by Warner et al. includes important information regarding the impact of the administration of cricoid pressure. In the 49 claims that included endotracheal intubation, cricoid pressure was applied in 22 (45%) and not applied in 19 (39%). In other words, in this cohort pulmonary aspiration was reported more often during than in the absence of applied cricoid pressure. This finding reemphasizes the lack of scientific evidence for a protective effect of cricoid pressure application.2–4  The authors explicitly acknowledge this fact. Therefore, the onsite anesthesiologist reviewers’ judgment that lack of use of cricoid pressure contributed to aspirations in 15 claims is unjustified.

Administration of cricoid pressure has been documented to be associated with numerous adverse effects, including provocation of gagging and vomiting when applied early during induction of anesthesia; worsening of laryngoscopic and intubating conditions...

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