Manual versus pressure‐controlled facemask ventilation during the induction of general anaesthesia in children: a prospective randomised controlled study

Abstract

Background

Gastric 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 anaesthesia induction in children.

Methods

Children in the pressure‐controlled ventilation group (n = 76) received pressure‐controlled facemask ventilation at an inspiratory pressure of 13 cmH₂O. In the manual ventilation group (n = 75), facemask ventilation was manually performed by anaesthesiologists, who tried to maintain an inspiratory pressure of 13 cmH₂O. The adjustable pressure limiting valve was set at 13 cmH₂O. The incidence of gastric insufflation during 90 s after the initiation of ventilation was assessed using epigastric auscultation and gastric ultrasonography.

Results

The incidence of gastric insufflation was significantly higher in the MV 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) cmH₂O vs. 13.0 (0.1) cmH₂O; 95% CI of differences, 2.36–3.71 cmH₂O; P < 0.001]. The manual ventilation group exhibited a wide peak airway pressure range (11–26 cmH₂O) and a wide variation of tidal volume (0–7.0 ml/kg) compared with those of the pressure‐controlled ventilation group (13–14 cmH₂O and 0.6–16.0 ml/kg, respectively).

Conclusions

At an inspiratory pressure of 13 cmH₂O, pressure‐controlled ventilation may be more effective than manual ventilation in preventing gastric insufflation while providing stable ventilation in children.

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