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Ultrasound-guided esophageal compression during mask ventilation in small children: a prospective observational study

Eun-Hee Kim1, Sung-Ae Cho2, Pyoyoon Kang1

  • 1Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehakno, Jongnogu, Seoul, 03080, Republic of Korea.

BMC Anesthesiology
|August 15, 2022
PubMed

Insights

Real-time ultrasound-guided esophageal compression effectively prevents gastric insufflation during face-mask ventilation in young children. This technique offers a promising alternative to cricoid compression for airway management in pediatric anesthesia.

Area of Science:

  • Anesthesiology
  • Pediatric Anesthesia
  • Airway Management

Background:

  • Cricoid compression for preventing gastric insufflation is controversial, especially in children.
  • Limited evidence exists for its efficacy and safety in pediatric patients.
  • Alternative methods for preventing gastric insufflation are needed.

Purpose of the Study:

  • To evaluate the effectiveness of real-time ultrasound-guided esophageal compression in preventing gastric insufflation.
  • To assess the safety and feasibility of this technique in children under 2 years old.
  • To determine the pressure threshold for gastric insufflation during face-mask ventilation with esophageal compression.

Main Methods:

  • Prospective observational study involving 42 children under 2 years old undergoing general anesthesia.
  • Ultrasound-guided esophageal compression applied during pressure-controlled face-mask ventilation.
  • Gradual increase in peak inspiratory pressure to identify the point of gastric insufflation.

Main Results:

  • Gastric insufflation occurred in only 2 (4.7%) of the analyzed patients.
  • Esophageal positioning was predominantly on the left side of the trachea.
  • Ultrasound-guided esophageal compression did not significantly impact the percentage of glottic opening scores (P=0.220).

Conclusions:

  • Real-time ultrasound-guided esophageal compression is effective in preventing gastric insufflation during face-mask ventilation in infants and young children.
  • This technique provides a potentially safer alternative to cricoid compression.
  • Further research may explore its application in broader pediatric populations.
Abstract

Keywords:
Cricoid compressionEsophagusPediatric patientsUltrasonography

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