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Kim EH, Cho SA, Kang P, Song IS, Ji SH, Jang YE, Lee JH, Kim JT, Kim HS. Ultrasound-guided esophageal compression during mask ventilation in small children: a prospective observational study. BMC Anesthesiol 2022; 22:257. [PMID: 35971064 PMCID: PMC9377106 DOI: 10.1186/s12871-022-01803-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 08/08/2022] [Indexed: 11/12/2022] Open
Abstract
Background The use of cricoid compression to prevent insufflation remains controversial, and its use in children is limited. This study aimed to examine the effect of real-time ultrasound-guided esophageal compression on the prevention of gastric insufflation. Method This prospective observational study was conducted with fifty children aged < 2 years undergoing general anesthesia. Patients were excluded if they were at an increased risk for gastric regurgitation or pulmonary aspiration. Following anesthetic induction under spontaneous breathing, ultrasound-guided esophageal compression was performed during pressure-controlled face-mask ventilation using a gradual increase in peak inspiratory pressure from 10 to 24 cm H2O to determine the pressure at which gastric insufflation occurred. The primary outcome was the incidence of gastric insufflation during anesthetic induction with variable peak inspiratory pressure after real-time ultrasound-guided esophageal compression was applied. Results Data from a total of 42 patients were analyzed. Gastric insufflation was observed in 2 (4.7%) patients. All patients except one had their esophagus on the left side of the trachea. Applying ultrasound-guided esophageal compression did not affect the percentage of glottic opening scores (P = 0.220). Conclusions The use of real-time ultrasound-guided esophageal compression pressure can aid preventing gastric insufflation during face-mask ventilation in children less than 2 years old. Trial registration Clinicaltrials.gov identifier: NCT04645043. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-022-01803-5.
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Affiliation(s)
- Eun-Hee Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehakno, Jongnogu, Seoul, 03080, Republic of Korea
| | - Sung-Ae Cho
- Department of Anesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, 158 Gwanjeodong-ro, Seo-gu, Daejeon, 35365, Republic of Korea
| | - Pyoyoon Kang
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehakno, Jongnogu, Seoul, 03080, Republic of Korea
| | - In-Sun Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehakno, Jongnogu, Seoul, 03080, Republic of Korea
| | - Sang-Hwan Ji
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehakno, Jongnogu, Seoul, 03080, Republic of Korea
| | - Young-Eun Jang
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehakno, Jongnogu, Seoul, 03080, Republic of Korea
| | - Ji-Hyun Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehakno, Jongnogu, Seoul, 03080, Republic of Korea
| | - Jin-Tae Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehakno, Jongnogu, Seoul, 03080, Republic of Korea
| | - Hee-Soo Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehakno, Jongnogu, Seoul, 03080, Republic of Korea.
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EmayahTenzing, A V. 7: Comparison of real-time cervical oesophageal ultrasonography and gastric antral ultrasonography to detect gastric insufflation during face-mask ventilation under general anaesthesia-Aprospective observational study. Indian J Anaesth 2022; 66. [PMCID: PMC9116811 DOI: 10.4103/0019-5049.340659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2022] Open
Abstract
Background and Aims: Face mask ventilation (FMV) is live saving. It is paramount to maintain oxygenation and ventilation. But FMV is avoided in rapid sequence induction( RSI), for fear of gastric insufflation. Gastric insufflation predisposes the patient to pulmonary aspiration. But the current methods available to detect gastric insufflation are not reliable markers. These include epigastric auscultation for insufflated gases, insertion of nasogastric tube to aspirate and measure the gases, and gastric antral cross-sectional area (CSA) measurement. Each of the above have their own limitations. So, reliable markers denoting gastric insufflation can prevent pulmonary aspiration and can enable “safe” FMV. Real-time transcutaneous ultrasonography(USG) of cervical oesophagus during FMV was done to look for comet-tail artefacts (acoustic shadows created by entrainment of gases into digestive tract)The aim of this study was to compare real-time upper cervical USG with gastric antral USG to detect gastric insufflation during FMV under general anaesthesia. Methods: Results: Ninety patients were recruited. One case of accidental intubation was withdrawn. Remaining 89 patients were analysed. There was an increased incidence of comet-tail artefacts in the oesophagus when compared to gastric antrum. This difference was statistically significant as analysed by Mcnemar test. The lowest peak airway pressure at which comet-tail artefacts appeared in oesophagus was 21.47 (SD-2.86) cm H20. Conclusion: Cervical oesophageal USG is better than gastric antral USG in identifying insufflation of gas into digestive tract. Limiting the airway pressures to < 20 cm H2O would be safer in providing safe FMV without cricoid pressure. Real-time USG monitoring of oesophagus in the neck for comet-tail artefacts is useful in early identification of early gastrooesophageal insufflation. ![]()
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Affiliation(s)
- EmayahTenzing
- Department of Anaesthesiology and Critical Care, JIPMER, Puducherry
| | - Vasudevan A
- Department of Anaesthesiology and Critical Care, JIPMER, Puducherry
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Tang JX, Wang L, Nian WQ, Tang WY, Xiao JY, Tang XX, Liu HL. Aspiration pneumonia during general anesthesia induction after esophagectomy: A case report. World J Clin Cases 2020; 8:5409-5414. [PMID: 33269277 PMCID: PMC7674742 DOI: 10.12998/wjcc.v8.i21.5409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/05/2020] [Accepted: 08/19/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Esophageal cancer is a common malignant tumor of the digestive system. At present, surgery is the most important treatment strategy. After esophagectomy and gastric esophagoplasty, the patients are prone to regurgitation. However, these patients currently do not receive much attention, especially from anesthesiologists.
CASE SUMMARY A 55-year-old woman was scheduled for right lower lung lobectomy. The patient had undergone radical surgery for esophageal cancer under general anesthesia 6 mo prior. Although the patient had fasted for > 17 h, unexpected aspiration still occurred during induction of general anesthesia. Throughout the operation, oxygen saturation was 98%-100%, but the airway pressure was high (35 cmH2O at double lung ventilation). The patient was sent to the intensive care unit after surgery. Bedside chest radiography was performed, which showed exudative lesions in both lungs compared with the preoperative image. After surgery, antibiotics were given to prevent lung infection. On day 2 in the intensive care unit, the patient was extubated and discharged on postoperative day 7 without complications related to aspiration pneumonia.
CONCLUSION After esophagectomy, patients are prone to regurgitation. We recommend nasogastric tube placement followed by rapid sequence induction or conscious intubation.
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Affiliation(s)
- Jia-Xi Tang
- Department of Anesthesiology, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing 400030, China
| | - Ling Wang
- Department of Phase I Clinical Trial Ward, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing 400030, China
| | - Wei-Qi Nian
- Department of Phase I Clinical Trial Ward, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing 400030, China
| | - Wan-Yan Tang
- Department of Phase I Clinical Trial Ward, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing 400030, China
| | - Jing-Yu Xiao
- Department of Anesthesiology, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing 400030, China
| | - Xi-Xi Tang
- Department of Anesthesiology, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing 400030, China
| | - Hong-Liang Liu
- Department of Anesthesiology, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing 400030, China
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