In Reply:—

We appreciate the letters by Cox and Harle et al.  Because pulmonary aspiration of a milk–cream mixture is rare, our report was intended to describe the clinical course of this complication. 1 

Although the safe time interval for delaying anesthesia after oral ingestion of milk or cream is unknown in adult patients, Dr. Cox’s suggestion of at least 6 h seems reasonable.

As we stated in our original report, we, similar to Harle et al. , believe that administration of this mixture through a jejunostomy tube is preferable because this would reduce the risk of pulmonary aspiration. Dr. Orringer has extensive experience with these patients, so it is reassuring to learn that he and his coauthors are unaware of significant cases of pulmonary aspiration in their patients after application of cricoid pressure. Based on their suggestions, we will continue to apply cricoid pressure to these patients, recognizing that even in healthy patients, this maneuver is not always effective. 2 

Brodsky JB, Brock-Utne AJ, Levi DC, Ikonomidis JS, Whyte RI: Pulmonary aspiration of a milk/cream mixture. A nesthesiology 1999; 91: 1533–4
Tournadre JP, Chassard D, Berrada KR, Bouletreau P: Cricoid cartilage pressure decreases lower esophageal sphincter tone. A nesthesiology 1997; 86: 7–9