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He G, Ma L, Tian K, Cao Y, Qin Z. Effect of facemask oxygenation with and without positive pressure ventilation on gastric volume during anesthesia induction in patients undergoing laparoscopic cholecystectomy or partial hepatectomy: a randomized controlled trial. BMC Anesthesiol 2022; 22:412. [PMID: 36581835 PMCID: PMC9801608 DOI: 10.1186/s12871-022-01958-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Studies focusing on the relationship between gastric volume and facemask oxygenation without ventilation during apnea in anesthesia induction are scarce. This study compared the change in gastric volume during apnea in anesthesia induction using facemask ventilation and facemask oxygenation without ventilation in adults undergoing laparoscopic surgery. METHODS In this prospective, randomized, double-blinded trial, 70 adults undergoing laparoscopic surgery under general anesthesia were divided into two groups to receive facemask oxygenation with and without ventilation for 60 seconds after loss of consciousness. Before anesthesia induction and after endotracheal intubation, the gastric antral cross-sectional area was measured with ultrasound imaging. Arterial blood gases were tested at baseline (T1), after preoxygenation (T2), after loss of consciousness (T3), and before and after endotracheal intubation (T4 and T5, respectively). RESULTS Sixty patients were included (ventilation n = 30; non ventilation n = 30, 10 patients were excluded). The median [IQR] change of gastric antral cross-sectional area in ventilation group was significantly higher than in non ventilation group (0.83 [0.20 to 1.54] vs. 0.10 [- 0.11 to 0.56] cm2, P = 0.001). At T4 and T5, the PaO2 in ventilation group was significantly higher than in non ventilation group (T4: 391.83 ± 61.53 vs. 336.23 ± 74.99 mmHg, P < 0.01; T5: 364.00 ± 58.65 vs. 297.13 ± 86.95 mmHg, P < 0.01), while the PaCO2 in non ventilation group was significantly higher (T4: 46.57 ± 5.78 vs. 37.27 ± 6.10 mmHg, P < 0.01; T5: 48.77 ± 6.59 vs. 42.63 ± 6.03 mmHg, P < 0.01) and the pH value in non ventilation group was significantly lower (T4: 7.35 ± 0.029 vs 7.42 ± 0.047, P < 0.01; T5: 7.34 ± 0.033 vs 7.39 ± 0.044, P < 0.01). At T4, the HCO3- in non ventilation group was significantly higher (25.79 ± 2.36 vs. 23.98 ± 2.18 mmol l- 1, P < 0.01). CONCLUSIONS During apnoea, the increase in gastric volume was milder in patients undergoing facemask oxygenation without ventilation than with positive pressure ventilation. TRIAL REGISTRATION ChiCTR2100054193, 10/12/2021, Title: "Effect of positive pressure and non-positive pressure ventilation on gastric volume during induction of general anesthesia in laparoscopic surgery: a randomized controlled trial". Website: https://www.chictr.ogr.cn .
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Affiliation(s)
- Guangting He
- grid.284723.80000 0000 8877 7471Department of Anesthesiology, NanFang Hospital, Southern Medical University, 1838 Guangzhou Avenue North, Guangzhou, 510515 People’s Republic of China
| | - Liyun Ma
- grid.284723.80000 0000 8877 7471Department of Anesthesiology, NanFang Hospital, Southern Medical University, 1838 Guangzhou Avenue North, Guangzhou, 510515 People’s Republic of China
| | - Ke Tian
- grid.284723.80000 0000 8877 7471Department of Anesthesiology, NanFang Hospital, Southern Medical University, 1838 Guangzhou Avenue North, Guangzhou, 510515 People’s Republic of China
| | - Yuqi Cao
- grid.284723.80000 0000 8877 7471Department of Anesthesiology, NanFang Hospital, Southern Medical University, 1838 Guangzhou Avenue North, Guangzhou, 510515 People’s Republic of China
| | - Zaisheng Qin
- grid.284723.80000 0000 8877 7471Department of Anesthesiology, NanFang Hospital, Southern Medical University, 1838 Guangzhou Avenue North, Guangzhou, 510515 People’s Republic of China
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Evaluation of adequacy of ventilation and gastric insufflation at three levels of inspiratory pressure for facemask ventilation during induction of anaesthesia: A randomised controlled trial. Anaesth Crit Care Pain Med 2022; 41:101132. [PMID: 35901954 DOI: 10.1016/j.accpm.2022.101132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/20/2022] [Accepted: 05/21/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND In this study, we aimed to compare three inspiratory pressures during face-mask ventilation in paralysed patients regarding the subsequent incidence of gastric insufflation and the adequacy of lung ventilation. METHODS In this randomised controlled trial, we included adult patients undergoing elective surgery under general anaesthesia. The patients were randomly allocated to receive positive inspiratory pressure (PIP) of 10, 15, or 20 cmH2O during pressure-controlled mask ventilation. Antral cross-sectional area (CSA) was assessed by ultrasound at baseline before mask ventilation and after endotracheal intubation and gastric insufflation was defined as increased CSA after endotracheal intubation > 30% of the baseline measurement. The primary outcome was the incidence of gastric insufflation. Other outcomes included the tidal volume, and the incidence of adequate ventilation (tidal volume of 6-10 mL/kg predicted body weight). RESULTS We analysed data from 36 patients in each group. The number of patients with gastric insufflation was lowest in the PIP 10 group (0/36 [0%]) in comparison with PIP 15 (2/36 [19%] and PIP 20 36/36 [100%] groups (P-values of 0.019 and < 0.001, respectively). The probability of adequate ventilation at any time point was the highest in PIP 10, followed by PIP 15, and was the lowest in the PIP 20 group. CONCLUSION An inspiratory pressure of 10 cmH2O in paralysed patients provided the least risk of gastric insufflation with adequate ventilation during induction of general anaesthesia compared to inspiratory pressure of 15- and 20 cmH2O.
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Valla FV, Tume LN, Jotterand Chaparro C, Arnold P, Alrayashi W, Morice C, Nabialek T, Rouchaud A, Cercueil E, Bouvet L. Gastric Point-of-Care Ultrasound in Acutely and Critically Ill Children (POCUS-ped): A Scoping Review. Front Pediatr 2022; 10:921863. [PMID: 35874585 PMCID: PMC9298849 DOI: 10.3389/fped.2022.921863] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Point-of-care ultrasound (POCUS) use is increasing in pediatric clinical settings. However, gastric POCUS is rarely used, despite its potential value in optimizing the diagnosis and management in several clinical scenarios (i.e., assessing gastric emptying and gastric volume/content, gastric foreign bodies, confirming nasogastric tube placement, and hypertrophic pyloric stenosis). This review aimed to assess how gastric POCUS may be used in acute and critically ill children. Materials and Methods An international expert group was established, composed of pediatricians, pediatric intensivists, anesthesiologists, radiologists, nurses, and a methodologist. A scoping review was conducted with an aim to describe the use of gastric POCUS in pediatrics in acute and critical care settings. A literature search was conducted in three databases, to identify studies published between 1998 and 2022. Abstracts and relevant full texts were screened for eligibility, and data were extracted, according to the JBI methodology (Johanna Briggs Institute). Results A total of 70 studies were included. Most studies (n = 47; 67%) were conducted to assess gastric emptying and gastric volume/contents. The studies assessed gastric volume, the impact of different feed types (breast milk, fortifiers, and thickeners) and feed administration modes on gastric emptying, and gastric volume/content prior to sedation or anesthesia or during surgery. Other studies described the use of gastric POCUS in foreign body ingestion (n = 6), nasogastric tube placement (n = 5), hypertrophic pyloric stenosis (n = 8), and gastric insufflation during mechanical ventilatory support (n = 4). POCUS was performed by neonatologists, anesthesiologists, emergency department physicians, and surgeons. Their learning curve was rapid, and the accuracy was high when compared to that of the ultrasound performed by radiologists (RADUS) or other gold standards (e.g., endoscopy, radiography, and MRI). No study conducted in critically ill children was found apart from that in neonatal intensive care in preterms. Discussion Gastric POCUS appears useful and reliable in a variety of pediatric clinical settings. It may help optimize induction in emergency sedation/anesthesia, diagnose foreign bodies and hypertrophic pyloric stenosis, and assist in confirming nasogastric tube placement, avoiding delays in obtaining confirmatory examinations (RADUS, x-rays, etc.) and reducing radiation exposure. It may be useful in pediatric intensive care but requires further investigation.
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Affiliation(s)
- Frederic V. Valla
- Pediatric Intensive Care, Lyon University Children Hospital, Hospices Civils de Lyon, Lyon, France
| | - Lyvonne N. Tume
- School of Health and Society, University of Salford, Manchester, United Kingdom
| | - Corinne Jotterand Chaparro
- Department of Nutrition and Dietetics, Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland
| | - Philip Arnold
- Department of Anaesthetics, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Walid Alrayashi
- Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston Children's Hospital, Boston, MA, United States
| | - Claire Morice
- Pediatric Intensive Care, Lyon University Children Hospital, Hospices Civils de Lyon, Lyon, France
| | - Tomasz Nabialek
- Pediatric Intensive Care, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Aymeric Rouchaud
- Pediatric Radiology Department, Lyon University Children Hospital, Hospices Civils de Lyon, Lyon, France
| | - Eloise Cercueil
- Pediatric Intensive Care, Lyon University Children Hospital, Hospices Civils de Lyon, Lyon, France
| | - Lionel Bouvet
- Department of Anesthesiology and Intensive Care, Lyon University Children Hospital, Hospices Civils de Lyon, Lyon, France
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dos Santos Neto JM, de Carvalho CC, de Andrade LB, Dos Santos TGB, Andrade RGADC, Fernandes RAML, de Orange FA. Continuous positive airway pressure to reduce the risk of early peripheral oxygen desaturation after onset of apnoea in children: A double-blind randomised controlled trial. PLoS One 2021; 16:e0256950. [PMID: 34597324 PMCID: PMC8486132 DOI: 10.1371/journal.pone.0256950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 07/30/2021] [Indexed: 11/18/2022] Open
Abstract
Continuous positive airway pressure (CPAP) during anaesthesia induction improves oxygen saturation (SpO2) outcomes in adults subjected to airway manipulation, and could similarly support oxygenation in children. We evaluated whether CPAP ventilation and passive CPAP oxygenation in children would defer a SpO2 decrease to 95% after apnoea onset compared to the regular technique in which no positive airway pressure is applied. In this double-blind, parallel, randomised controlled clinical trial, 68 children aged 2–6 years with ASA I–II who underwent surgery under general anaesthesia were divided into CPAP and control groups (n = 34 in each group). The intervention was CPAP ventilation and passive CPAP oxygenation using an anaesthesia workstation. The primary outcome was the elapsed time until SpO2 decreased to 95% during a follow-up period of 300 s from apnoea onset (T1). We also recorded the time required to regain baseline levels from an SpO2 of 95% aided by positive pressure ventilation (T2). The median T1 was 278 s (95% confidence interval [CI]: 188–368) in the CPAP group and 124 s (95% CI: 92–157) in the control group (median difference: 154 s; 95% CI: 58–249; p = 0.002). There were 17 (50%) and 32 (94.1%) primary events in the CPAP and control groups, respectively. The hazard ratio was 0.26 (95% CI: 0.14–0.48; p<0.001). The median for T2 was 21 s (95% CI: 13–29) and 29 s (95% CI: 22–36) in the CPAP and control groups, respectively (median difference: 8 s; 95% CI: -3 to 19; p = 0.142). SpO2 was significantly higher in the CPAP group than in the control group throughout the consecutive measures between 60 and 210 s (with p ranging from 0.047 to <0.001). Thus, in the age groups examined, CPAP ventilation and passive CPAP oxygenation deferred SpO2 decrease after apnoea onset compared to the regular technique with no positive airway pressure.
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Affiliation(s)
- Jayme Marques dos Santos Neto
- Support and Therapeutic Diagnosis Division, Anesthesiology and Post-Anesthetic Care Unit, Federal University of Pernambuco’s Teaching Hospital, Recife, Pernambuco, Brazil
- * E-mail:
| | - Clístenes Cristian de Carvalho
- Department of Post-graduation, Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Pernambuco, Brazil
- Department of Surgery, Federal University of Campina Grande, Campina Grande, Paraíba, Brazil
| | - Lívia Barboza de Andrade
- Department of Post-graduation, Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Pernambuco, Brazil
| | - Thiago Gadelha Batista Dos Santos
- Support and Therapeutic Diagnosis Division, Anesthesiology and Post-Anesthetic Care Unit, Federal University of Pernambuco’s Teaching Hospital, Recife, Pernambuco, Brazil
| | | | | | - Flavia Augusta de Orange
- Support and Therapeutic Diagnosis Division, Anesthesiology and Post-Anesthetic Care Unit, Federal University of Pernambuco’s Teaching Hospital, Recife, Pernambuco, Brazil
- Department of Post-graduation, Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Pernambuco, Brazil
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Van de Voorde P, Turner NM, Djakow J, de Lucas N, Martinez-Mejias A, Biarent D, Bingham R, Brissaud O, Hoffmann F, Johannesdottir GB, Lauritsen T, Maconochie I. [Paediatric Life Support]. Notf Rett Med 2021; 24:650-719. [PMID: 34093080 PMCID: PMC8170638 DOI: 10.1007/s10049-021-00887-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 12/11/2022]
Abstract
The European Resuscitation Council (ERC) Paediatric Life Support (PLS) guidelines are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations of the International Liaison Committee on Resuscitation (ILCOR). This section provides guidelines on the management of critically ill or injured infants, children and adolescents before, during and after respiratory/cardiac arrest.
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Affiliation(s)
- Patrick Van de Voorde
- Department of Emergency Medicine, Faculty of Medicine UG, Ghent University Hospital, Gent, Belgien
- Federal Department of Health, EMS Dispatch Center, East & West Flanders, Brüssel, Belgien
| | - Nigel M. Turner
- Paediatric Cardiac Anesthesiology, Wilhelmina Children’s Hospital, University Medical Center, Utrecht, Niederlande
| | - Jana Djakow
- Paediatric Intensive Care Unit, NH Hospital, Hořovice, Tschechien
- Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno, Medical Faculty of Masaryk University, Brno, Tschechien
| | | | - Abel Martinez-Mejias
- Department of Paediatrics and Emergency Medicine, Hospital de Terassa, Consorci Sanitari de Terrassa, Barcelona, Spanien
| | - Dominique Biarent
- Paediatric Intensive Care & Emergency Department, Hôpital Universitaire des Enfants, Université Libre de Bruxelles, Brüssel, Belgien
| | - Robert Bingham
- Hon. Consultant Paediatric Anaesthetist, Great Ormond Street Hospital for Children, London, Großbritannien
| | - Olivier Brissaud
- Réanimation et Surveillance Continue Pédiatriques et Néonatales, CHU Pellegrin – Hôpital des Enfants de Bordeaux, Université de Bordeaux, Bordeaux, Frankreich
| | - Florian Hoffmann
- Pädiatrische Intensiv- und Notfallmedizin, Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Ludwig-Maximilians-Universität, München, Deutschland
| | | | - Torsten Lauritsen
- Paediatric Anaesthesia, The Juliane Marie Centre, University Hospital of Copenhagen, Kopenhagen, Dänemark
| | - Ian Maconochie
- Paediatric Emergency Medicine, Faculty of Medicine Imperial College, Imperial College Healthcare Trust NHS, London, Großbritannien
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Abstract
BACKGROUND Rapid sequence induction (RSI) is a standard procedure, which should be implemented in all patients with a risk of aspiration/regurgitation during anaesthesia induction. OBJECTIVE The primary aim was to evaluate clinical practice in RSI, both in adult and paediatric populations. DESIGN Online survey. SETTINGS A total of 56 countries. PARTICIPANTS Members of the European Society of Anaesthesiology. MAIN OUTCOME MEASURES The aim was to identify and describe the actual clinical practice of RSI related to general anaesthesia. RESULTS From the 1921 respondents, 76.5% (n=1469) were qualified anaesthesiologists. When anaesthetising adults, the majority (61.7%, n=1081) of the respondents preoxygenated patients with 100% O2 for 3 min and 65.9% (n=1155) administered opioids during RSI. The Sellick manoeuvre was used by 38.5% (n=675) and was not used by 37.4% (n=656) of respondents. First-line medications for a haemodynamically stable adult patient were propofol (90.6%, n=1571) and suxamethonium (56.0%, n=932). Manual ventilation (inspiratory pressure <12 cmH2O) was used in 35.5% (n=622) of respondents. In the majority of paediatric patients, 3 min of preoxygenation (56.6%, n=817) and opioids (54.9%, n=797) were administered. The Sellick manoeuvre and manual ventilation (inspiratory pressure <12 cmH2O) in children were used by 23.5% (n=340) and 35.9% (n=517) of respondents, respectively. First-line induction drugs for a haemodynamically stable child were propofol (82.8%, n=1153) and rocuronium (54.7%, n=741). CONCLUSION We found significant heterogeneity in the daily clinical practice of RSI. For patient safety, our findings emphasise the need for international RSI guidelines. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03694860
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Effect of spontaneous breathing on atelectasis during induction of general anaesthesia in infants: A prospective randomised controlled trial. Eur J Anaesthesiol 2021; 37:1150-1156. [PMID: 33009186 DOI: 10.1097/eja.0000000000001327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Atelectasis occurs commonly during induction of general anaesthesia in children, particularly infants. OBJECTIVES We hypothesised that maintaining spontaneous ventilation can reduce atelectasis formation during anaesthetic induction in infants. We compared spontaneous ventilation and manual positive-pressure ventilation in terms of atelectasis formation in infants. DESIGN Randomised controlled study. SETTING Single tertiary hospital in Seoul, Republic of Korea, from November 2018 to December 2019. PATIENTS We enrolled 60 children younger than 1 year of age undergoing general anaesthesia, of whom 56 completed the study. Exclusion criteria were history of hypoxaemia during previous general anaesthesia, development of a respiratory tract infection within 1 month, current intubation or tracheostomy cannulation, need for rapid sequence intubation, preterm birth, age within 60 weeks of the postconceptional age and the presence of contraindications for rocuronium or sodium thiopental. INTERVENTION Patients were allocated randomly to either the 'spontaneous' group or 'controlled' group. During preoxygenation, spontaneous ventilation was maintained in the 'spontaneous' group while conventional bag-mask ventilation was provided in the 'controlled' group. After 5 min of preoxygenation, a lung ultrasound examination was performed to compare atelectasis formation in the two groups. RESULTS Atelectasis after preoxygenation was seen in seven (26.9%) of 26 patients in the 'spontaneous' group and 22 (73.3%) of 30 patients in the 'controlled' group (P = 0.001). The relative risk of atelectasis in the 'spontaneous' group was 0.39 (95% CI 0.211 to 0.723). Regarding ultrasound pictures of consolidation, the total score and sum of scores in the dependent regions were significantly lower in the 'spontaneous' group than in the 'controlled' group (P = 0.007 and 0.001, respectively). CONCLUSION Maintaining spontaneous ventilation during induction of general anaesthesia has a preventive effect against atelectasis in infants younger than 1 year of age, particularly in the dependent portions of the lungs. TRIAL REGISTRATION Clinicaltrials.gov (identifier: NCT03739697).
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Van de Voorde P, Turner NM, Djakow J, de Lucas N, Martinez-Mejias A, Biarent D, Bingham R, Brissaud O, Hoffmann F, Johannesdottir GB, Lauritsen T, Maconochie I. European Resuscitation Council Guidelines 2021: Paediatric Life Support. Resuscitation 2021; 161:327-387. [PMID: 33773830 DOI: 10.1016/j.resuscitation.2021.02.015] [Citation(s) in RCA: 151] [Impact Index Per Article: 50.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
These European Resuscitation Council Paediatric Life Support (PLS) guidelines, are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the management of critically ill infants and children, before, during and after cardiac arrest.
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Affiliation(s)
- Patrick Van de Voorde
- Department of Emergency Medicine Ghent University Hospital, Faculty of Medicine UG, Ghent, Belgium; EMS Dispatch Center, East & West Flanders, Federal Department of Health, Belgium.
| | - Nigel M Turner
- Paediatric Cardiac Anesthesiology, Wilhelmina Children's Hospital, University Medical Center, Utrecht, Netherlands
| | - Jana Djakow
- Paediatric Intensive Care Unit, NH Hospital, Hořovice, Czech Republic; Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno, Medical Faculty of Masaryk University, Brno, Czech Republic
| | | | - Abel Martinez-Mejias
- Department of Paediatrics and Emergency Medicine, Hospital de Terassa, Consorci Sanitari de Terrassa, Barcelona, Spain
| | - Dominique Biarent
- Paediatric Intensive Care & Emergency Department, Hôpital Universitaire des Enfants, Université Libre de Bruxelles, Brussels, Belgium
| | - Robert Bingham
- Hon. Consultant Paediatric Anaesthetist, Great Ormond Street Hospital for Children, London, UK
| | - Olivier Brissaud
- Réanimation et Surveillance Continue Pédiatriques et Néonatales, CHU Pellegrin - Hôpital des Enfants de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Florian Hoffmann
- Paediatric Intensive Care and Emergency Medicine, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | | | - Torsten Lauritsen
- Paediatric Anaesthesia, The Juliane Marie Centre, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Ian Maconochie
- Paediatric Emergency Medicine, Imperial College Healthcare Trust NHS, Faculty of Medicine Imperial College, London, UK
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Tianliang W, Gang S, Guocan Y, Haixing F. Effect of facemask ventilation with different ventilating volumes on gastric insufflation during anesthesia induction in patients undergoing laparoscopic cholecystectomy. Saudi Med J 2020; 40:989-995. [PMID: 31588476 PMCID: PMC6887889 DOI: 10.15537/smj.2019.10.24306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objectives: To compare the occurrence of gastric insufflation during anesthesia induction in patients undergoing laparoscopic cholecystectomy, using facemask ventilation with different ventilation volumes. Methods: This is a prospective study of 54 patients undergoing laparoscopic cholecystectomy under general anesthesia between January 2018 and June 2018. Facemask ventilation with volume mode controlled at 6 ml/kg (group V6), 8 ml/kg (group V8) or 10 ml/kg (group V10) was applied for 120 seconds (sec) during anesthesia induction. Before facemask ventilation and at 120 sec of facemask ventilation, gastric insufflation was determined by ultrasonography. Gastric insufflation was also evaluated using direct vision of laparoscopy. Respiratory parameters were monitored. Results: The incidence of gastric insufflation in group V10 (55.6%) was significantly higher than that in groups V6 (11.1%) and V8 (16.7%). However, it showed no significant difference between groups V6 and V8. During facemask ventilation for 120 sec, carbon dioxide accumulation trend occurred in group V6, and group V10 exhibited evidence of hyper-ventilation. Group V8 might be considered the best balance between low gastric insufflation and effective lung ventilation. Conclusion: Facemask ventilation with a ventilation volume of 8 ml/kg seems to have adequate preoxygenation and avoid excessive gastric insufflation during anesthesia induction in laparoscopic cholecystectomy.
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Affiliation(s)
- Wu Tianliang
- Department of Anesthesiology, First People's Hospital of Fuyang District, Hangzhou, China. E-mail.
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Jung KT, Kim SH, Kim DJ, Kim SH, An TH. Effect of gastric decompression on postoperative vomiting in pediatric patients undergoing strabismus surgery: a randomized controlled study. Anesth Pain Med (Seoul) 2020; 15:66-72. [PMID: 33329792 PMCID: PMC7713869 DOI: 10.17085/apm.2020.15.1.66] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/25/2019] [Accepted: 07/27/2019] [Indexed: 11/17/2022] Open
Abstract
Background Postoperative vomiting (POV) is one of the most serious complications in pediatric patients undergoing strabismus surgery. This study was conducted to test the hypothesis that gastric decompression (GD) could prevent POV caused by gastric distension after mask ventilation. Methods A total of 60 pediatric patients (ASA PS I-II, aged one to 10 years) were randomly allocated to two groups; Group D (n = 30) and Group C (n = 30). Induction of anesthesia was performed with careful face mask ventilation with 100% O2 (3 L/min) and sevoflurane 3 vol% to limit airway pressure below 20 cmH2O. Endotracheal intubation was done after confirming adequate neuromuscular blockade. Then, the patients in Group D received GD, while patients in Group C did not. After the surgery, POV was assessed during the emergence from anesthesia in the operating room and postanesthetic care unit (30 min and 60 min). Results During the emergence, POV was significantly decreased in Group D compared to Group C (Group D 3.3% vs. Group C 30.0%, P = 0.006). The odds ratio analysis showed a lower incidence of POV in Group D (odds ratio = 0.080; 95% confidence limit: 0.009-0.685) during the emergence period. There was no significant difference in the incidence of POV in the postanesthetic care unit (Group D 6.7% vs. Group C 4.3% at 30 min, P = 1.000; 0% in both groups at 60 min). Conclusions GD reduced the incidence of POV in pediatric patients undergoing strabismus surgery during emergence.
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Affiliation(s)
- Ki Tae Jung
- Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju, Korea.,Department of Anesthesiology and Pain Medicine, School of Medicine, Chosun University, Gwangju, Korea
| | - Se Hun Kim
- Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju, Korea
| | - Dong Joon Kim
- Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju, Korea.,Department of Anesthesiology and Pain Medicine, School of Medicine, Chosun University, Gwangju, Korea
| | - Sang Hun Kim
- Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju, Korea.,Department of Anesthesiology and Pain Medicine, School of Medicine, Chosun University, Gwangju, Korea
| | - Tae Hun An
- Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju, Korea.,Department of Anesthesiology and Pain Medicine, School of Medicine, Chosun University, Gwangju, Korea
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