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 H2O. In the manual ventilation group (n = 75), facemask ventilation was manually performed by anesthesiologists, who tried to maintain an inspiratory pressure of 13 cm H2O. The adjustable pressure limiting valve was set at 13 cm H2O. 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 H2O vs 13.0 [0.1] cm H2O; 95% CI of differences, 2.36-3.71 cm H2O; P < 0.001). The manual ventilation group exhibited a wide peak airway pressure range (11-26 cm H2O) and a wide variation of tidal volume (0-7.0 mL/kg) compared with those of the pressure-controlled ventilation group (13-14 cm H2O and 0.6-16.0 mL/kg, respectively). Conclusion At an inspiratory pressure of 13 cm H2O, pressure-controlled ventilation may be more effective than manual ventilation in preventing gastric insufflation while providing stable ventilation in children.