Manual vs. pressure-controlled facemask ventilation for anaesthetic induction in paralysed children: a randomised controlled trial.
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 cmH2 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.


CONCLUSIONS
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.
Department of Anaesthesiology and Pain Medicine and Anaesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
J H
JH
Park
Department of Anaesthesiology and Pain Medicine and Anaesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
J Y
JY
Kim
Department of Anaesthesiology and Pain Medicine, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, Anyang, Korea.
J M
JM
Lee
Department of Anaesthesiology and Pain Medicine and Anaesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
Y H
YH
Kim
Department of Anaesthesiology and Pain Medicine, Ajou University College of Medicine, Suwon, Korea.
H W
HW
Jeong
Department of Anaesthesiology and Pain Medicine and Anaesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
H K
HK
Kil
D000768:Anesthesia, General / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008397:Masks; D011312:Pressure; D012121:Respiration, Artificial / Q000379:methods*; D013990:Tidal Volume