Manual vs pressure-controlled facemask ventilation during the induction of general anesthesia in children: A prospective randomized controlled study.

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 anesthesia induction in children.

Methods: Children in the pressure-controlled ventilation group (n = 76) received pressure-controlled facemask ventilation at an inspiratory pressure of 13 cm H 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 H O. The adjustable pressure limiting valve was set at 13 cm H O. The incidence of gastric insufflation during 90 seconds after the initiation of ventilation was assessed using epigastric auscultation and gastric ultrasonography.

Results: The 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 H O vs 13.0 [0.1] cm H O; 95% CI of differences, 2.36-3.71 cm H O; P < 0.001). The manual ventilation group exhibited a wide peak airway pressure  range (11-26 cm H 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 H O and 0.6-16.0 mL/kg, respectively).

Conclusion: At an inspiratory pressure of 13 cm H O, pressure-controlled ventilation may be more effective than manual ventilation in preventing gastric insufflation while providing stable ventilation in children.