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Manual vs. pressure‐controlled facemask ventilation for anaesthetic induction in paralysed children: a randomised controlled trial
Author(s) -
Park J. H.,
Kim J. Y.,
Lee J. M.,
Kim Y. H.,
Jeong H. W.,
Kil H. K.
Publication year - 2016
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.12737
Subject(s) - medicine , anesthesia , randomized controlled trial , controlled ventilation , ventilation (architecture) , surgery , mechanical engineering , engineering
Background During anaesthetic induction with a facemask, the inconsistent inspiratory flow with manual ventilation ( MV ) raises the peak airway pressure ( PAP ), which can be significantly higher than PAP during pressure‐controlled ventilation ( PCV ). In this study, PAP was compared between MV and PCV at the same tidal volume of 8–10 ml/kg during facemask ventilation for anaesthetic induction in children. The occurrence of gastric insufflation ( GI ) was evaluated with ultrasonography and stethoscopic auscultation. Methods Forty‐eight children, aged 0.5–7 years, undergoing elective urologic surgery were randomly allocated into either Group MV or Group PCV . Under light sedation with thiopental iv., ultrasonography ( US ) was performed and the gastric antrum was identified. After additional thiopental and rocuronium administration, facemask ventilation with a tidal volume of 8–10 ml/kg was performed for 3 min, whereas respiratory parameters were recorded at 1 min intervals. Real‐time US and stethoscopic auscultation were performed for evaluation of GI. Results In the MV group, PAP was higher at all the time points compared with the PCV group (14 vs. 9.5, 15 vs. 10 and 15 vs. 9 cmH 2 O, all P < 0.05). However, there was no difference in the GI occurrence between Group MV and Group PCV (7 vs. 3, P = 0.284). There was no difference between PAP in patients with GI and without GI ( P > 0.05). Ultrasonography was more sensitive in detecting GI than the stethoscopic auscultation (10 vs. 5). Gastric antral area was expanded after facemask ventilation in both groups, but there were no intergroup differences. Conclusion Although PCV provided lower PAP than MV at the same tidal volume, the risk of GI may not be eliminated during facemask ventilation in paralysed small children.