Ulrich Goebel1,2, Stefan Schumann1,2, Steffen Wirth3,4. 1. Department of Anesthesiology and Critical Care, Medical Center, University of Freiburg, Freiburg, Germany. 2. Faculty of Medicine, University of Freiburg, Freiburg, Germany. 3. Department of Anesthesiology and Critical Care, Medical Center, University of Freiburg, Freiburg, Germany. steffen.wirth@uniklinik-freiburg.de. 4. Faculty of Medicine, University of Freiburg, Freiburg, Germany. steffen.wirth@uniklinik-freiburg.de.
Abstract
PURPOSE:Facemask ventilation during the induction of general anesthesia in paediatric patients remains a challenge as it may result in hypoxic conditions and gastric insufflation with subsequent regurgitation and aspiration. So far, it is unclear if pressure-controlled or manual facemask ventilation is preferable in children. We hypothesized that pressure-controlled ventilation in apnoeic children results in lower peak airway pressure and flow rates compared to manual ventilation at comparable respiratory rates and tidal volumes. METHODS:Sixty-two lung-healthy children undergoing scheduled ear-nose-throat surgery were included in the study. After the induction of anesthesia, the patient's lungs were consecutively ventilated via a facemask in either manual or pressure-controlled mode, in randomized order. The primary outcome measure was peak airway pressure. Secondary outcome measures included positive end-expiratory pressure, airway compliance, tidal volume and airway flow. RESULTS: Data of 52 patients could be analyzed. Pressure-controlled ventilation resulted in a lower mean and peak inspiratory pressure (both p < 0.001), airway pressure amplitude (p = 0.01) and inspiratory peak flow rate (p = 0.005) compared to manual ventilation. The ratio of inspiration to expiration time was lower in pressure-controlled ventilation compared to manual ventilation (p < 0.001). CONCLUSION:Pressure-controlled facemask ventilation during induction of anesthesia in pediatric patients results in lower airway pressure, and lower flow rates compared to manual ventilation, at comparable tidal and minute volumes.
RCT Entities:
PURPOSE: Facemask ventilation during the induction of general anesthesia in paediatric patients remains a challenge as it may result in hypoxic conditions and gastric insufflation with subsequent regurgitation and aspiration. So far, it is unclear if pressure-controlled or manual facemask ventilation is preferable in children. We hypothesized that pressure-controlled ventilation in apnoeic children results in lower peak airway pressure and flow rates compared to manual ventilation at comparable respiratory rates and tidal volumes. METHODS: Sixty-two lung-healthy children undergoing scheduled ear-nose-throat surgery were included in the study. After the induction of anesthesia, the patient's lungs were consecutively ventilated via a facemask in either manual or pressure-controlled mode, in randomized order. The primary outcome measure was peak airway pressure. Secondary outcome measures included positive end-expiratory pressure, airway compliance, tidal volume and airway flow. RESULTS: Data of 52 patients could be analyzed. Pressure-controlled ventilation resulted in a lower mean and peak inspiratory pressure (both p < 0.001), airway pressure amplitude (p = 0.01) and inspiratory peak flow rate (p = 0.005) compared to manual ventilation. The ratio of inspiration to expiration time was lower in pressure-controlled ventilation compared to manual ventilation (p < 0.001). CONCLUSION: Pressure-controlled facemask ventilation during induction of anesthesia in pediatric patients results in lower airway pressure, and lower flow rates compared to manual ventilation, at comparable tidal and minute volumes.
Entities:
Keywords:
Gastric regurgitation; Patient safety; Pediatric anesthesia; Pressure support ventilation
Authors: Achim von Goedecke; Wolfgang G Voelckel; Volker Wenzel; Christoph Hörmann; Horst G Wagner-Berger; Volker Dörges; Karl H Lindner; Christian Keller Journal: Anesth Analg Date: 2004-01 Impact factor: 5.108