Abstract
BackgroundDuring facemask ventilation, gastric insufflation is defined as appearance of a comet-tail or an acoustic shadow on ultrasonography. Ultrasonographic measurement of antral cross-section area (CSA) may reflect an insufflated antrum and provide interesting semi-quantitative data in regard to the gastric insufflation. This study aimed to determine the appropriate level of inspiratory pressure sufficient to provide adequate pulmonary ventilation with a lower occurrence of gastric insufflation during facemask pressure-controlled ventilation using real-time ultrasonography in paralyzed children.MethodsNinety children, ASA I-II, aged from 2 to 4 years, scheduled for general anesthesia were enrolled in this randomized and double-blinded study. Children were randomized into one of the five groups (P8, P10, P12, P14, and P16) defined by the applied inspiratory pressure during facemask ventilation: 8, 10, 12, 14, and 16 cm H2O. Anesthesia induction was conducted with fentanyl and propofol. Rocuronium was administrated as a muscle relaxant. After rocuronium administration, facemask ventilation was performed for 120 s. Gastric insufflation (GI+) was detected by ultrasonography, and the antral CSA before and after facemask ventilation were also measured using ultrasonography. Respiratory variables were monitored.ResultsGastric insufflation was detected in 32 children (3/18 in group P8, 5/18 in group P10, 7/18 in group P12, 8/16 in group P14, and 9/14 in group P16). The antral CSA after facemask ventilation statistically increased in subgroups P14 GI+ and P16 GI+ for whom gastric insufflation was detected by ultrasonography, whereas it did not change statistically in other groups. Lung ventilation was inadequate for group P8 or P10.ConclusionWe concluded that an inspiratory pressure of 12 cm H2O is sufficient to provide adequate ventilation with a lower occurrence of gastric insufflation during induction of general anesthesia in paralyzed Chinese children aged from 2 to 4 years old.Trial registration(ChiCTR-IPR-16007960). Registered 21 February 2016Conclusion heading: Ultrasound for determining gastric insufflation
Highlights
During facemask ventilation, gastric insufflation is defined as appearance of a comet-tail or an acoustic shadow on ultrasonography
We evaluated the appropriate level of inspiratory pressure that allows adequate lung ventilation with a lower occurrence of gastric insufflation during facemask ventilation (FMV) using real-time ultrasonography in paralyzed children
We defined the significant increase in antral cross-section area (CSA) after FMV as gastric insufflation using an ultrasonography (SonoSite, Inc., Bothwell, WA) with a 2- to 5-MHz convex transducer
Summary
Gastric insufflation is defined as appearance of a comet-tail or an acoustic shadow on ultrasonography. This study aimed to determine the appropriate level of inspiratory pressure sufficient to provide adequate pulmonary ventilation with a lower occurrence of gastric insufflation during facemask pressure-controlled ventilation using real-time ultrasonography in paralyzed children. During the induction of general anesthesia, one critical risk factor for aspiration is gastric insufflation during facemask ventilation (FMV) [3]. The risk of gastric insufflation and the adverse complications are significantly reduced with pressure-controlled FMV compared with manual or volume-controlled FMV [5]. Using the traditional auscultation method, previous study determined the inspiratory pressure for preventing gastric insufflation during FMV to be 20 cm H2O in adult patients [6]. An inspiratory pressure less than 15 cm H2O determined by the auscultation method can provide safe ventilation without gastric insufflation during pressurecontrolled FMV [7]
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