Real-time Detection of Gastric Insufflation Related to Facemask Pressure–controlled Ventilation Using Ultrasonography of the Antrum and Epigastric Auscultation in Nonparalyzed Patients

Abstract

Inspiratory pressure of 15 cm H2O allowed for reduced occurrence of gastric insufflation with proper lung ventilation during induction of anesthesia with remifentanil and propofol in nonparalyzed and nonobese patients. (Anesthesiology 2014; 120:326-34).

Manual vs. pressure-controlled facemask ventilation for anaesthetic induction in paralysed children: a randomised controlled trial

“…1). [18][19][20] Next, a high-frequency linear probe was applied to obtain images from the same point as that in the sagittal scanning plane. The image acquisitions were repeated five times between the peristaltic antral contractions to accurately measure the outcome variables.…”

“…The air in the gastric antrum was defined as the appearance of an acoustic shadow, comet-tail artefact or ringdown artefact on US. 18,22 When the signs of GI appeared, the image was saved (Fig. 2).…”

“…One Acta Anaesthesiologica Scandinavica (2016) anaesthesiologist (experienced >5000 mask ventilations) performed the ventilation according to the groups, whereas another anaesthesiologist fixed a well-fitting transparent facemask (size #2, #3 or #4, depending on the size of the child; Kingsystems INFLATABLE FACE MASK TM , King Systems, Noblesville, IN, USA) using a two-handed jaw-thrust technique. 16,18,21 Inflatable bag of 1.5 l with a paediatric circle system of an anaesthesia machine (Primus TM , Dr€ ager Medical GmbH, L€ ubeck, Germany) was used for this study. Group MV received facemask ventilation to get a tidal volume of 8-10 ml/kg with a respiratory rate (RR) of 20/min and an inspiratory-to-expiratory (I:E) ratio of 1 : 2.…”

Cricoid pressure: The argument against

“…This is no longer the case, and research has shown that facemask ventilation using inflation pressures of less than 15cmH 2 O provides adequate ventilation without significant gastric insufflation, in the majority of non-obese individuals. 30 Two systematic reviews have since been conducted on CP, both of which showed no evidence for or against its use. 5,6 Moreover, a number of case reports, 31 surveys, 32 confidential enquiries 33 and national audits 13 have all shown that aspiration still occurs when CP is performed, with at least 11e14% of anaesthetists having witnessed aspiration during its application.…”

Optimizing Mask Ventilation: Literature Review and Development of a Conceptual Framework

“…Although newer evidence suggests that 15 cm H 2 O may cause less gastric insufflation, it might not be high enough to produce effective mask ventilation when difficult mask ventilation is encountered. 14,15 Facial hair and edentulism are 2 commonly encountered causes of inadequate seal. Facial hair can be shaved, although it is often undesired by patients and may not be feasible in emergency situations.…”