Pressure-controlled face mask ventilation during paediatric induction reduces gastric insufflation compared with manual ventilation.

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• Ji-Hyun Lee, Haesun Jung, Young-Eun Jang, Eun-Hee Kim, In-Kyung Song, Hee-Soo Kim, and Jin-Tae Kim.
• Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
• Paediatr Anaesth. 2019 Apr 1; 29 (4): 331-337.

BackgroundGastric insufflation frequently occurs during facemask ventilation in children. In the present study, we compared the incidence of gastric insufflation between pressure-controlled facemask ventilation and manual facemask ventilation during general anesthesia induction in children.MethodsChildren in the pressure-controlled ventilation group (n = 76) received pressure-controlled facemask ventilation at an inspiratory pressure of 13 cm H2 O. In the manual ventilation group (n = 75), facemask ventilation was manually performed by anesthesiologists, who tried to maintain an inspiratory pressure of 13 cm H2 O. The adjustable pressure limiting valve was set at 13 cm H2 O. The incidence of gastric insufflation during 90 seconds after the initiation of ventilation was assessed using epigastric auscultation and gastric ultrasonography.ResultsThe incidence of gastric insufflation was significantly higher in the manual  facemask ventilation group than in the pressure-controlled ventilation group (48% vs 12%, respectively; odds ratio 7.78, 95% confidence interval [CI] 3.38-17.9; P < 0.001). The mean peak airway pressure during ventilation was significantly higher in the manual ventilation group than in the pressure-controlled ventilation group (16.1 [3.0] cm H2 O vs 13.0 [0.1] cm H2 O; 95% CI of differences, 2.36-3.71 cm H2 O; P < 0.001). The manual ventilation group exhibited a wide peak airway pressure  range (11-26 cm H2 O) and a wide variation of tidal volume (0-7.0 mL/kg) compared with those of the pressure-controlled ventilation group (13-14 cm H2 O and 0.6-16.0 mL/kg, respectively).ConclusionAt an inspiratory pressure of 13 cm H2 O, pressure-controlled ventilation may be more effective than manual ventilation in preventing gastric insufflation while providing stable ventilation in children.© 2019 John Wiley & Sons Ltd.

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