Cricoid Pressure Not Protective in Patients that have Undergone Esophagectomy

In Response: As suggested by Dr. Hoftman (1), we agree that there are particular subsets of patients in whom cricoid pressure may not be effective in preventing perioperative pulmonary aspiration (2). One such scenario may, as Dr. Hoftman suggested, be the patient with a previous esophagectomy and gastric pull-through. Preoperative assessment of such an alteration of anatomy by image studies, surgical notes, and physical examination may help anesthesiologists modify their technique for the prevention of perioperative pulmonary aspiration. Tetsuro Sakai, MD, PhD Raymond M. Planinsic, MD Ibetsam I. Hilmi, MBCHB, FRCA Department of Anesthesiology UPMC Presbyterian/Montefiore Hospital University of Pittsburgh Medical Center University of Pittsburgh Pittsburgh, PA [email protected]