Clinical application of ultrasonography in monitoring gastric insufflation in children during induction of general anesthesia
HU Qiong1,2, ZHOU Bihua3, YAN Haiya2, LI Jun1.
1.Department of Anesthesiology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325027; 2.Department of Anesthesiology, Ningbo Women & Children’s Hospital, Ningbo, 315031; 3.Department of Ultrasound, Ningbo Women & Children’s Hospital, Ningbo, 315031
HU Qiong,ZHOU Bihua,YAN Haiya, et al. Clinical application of ultrasonography in monitoring gastric insufflation in children during induction of general anesthesia[J]. JOURNAL OF WEZHOU MEDICAL UNIVERSITY, 2016, 46(8): 571-574.
Abstract：Objective: To investigate the clinical value of ultrasonography in monitoring gastric insufflation related to facemask ventilation in pediatric patients during induction of general anesthesia. Methods: Fifty-four 2-4 years old male children received elective surgery under general anesthesia were randomized to 3 groups (P8, P12, and P16) defined by the PIP applied during PCV mode: 8, 12, and 16 cmH2O. Anesthesia was induced using fentanil, propofol and rocuronium in sequence. Once loss of eyelash reflex occurred, facemask pressure-controlled ventilation was started for a 120 s period while gastric insufflation was detected by real-time ultrasonographic monitoring. The antral cross-sectional area (CSA) was measured using ultrasonography before and after facemask ventilation. The noninvasive respiratory parameters were recorded at time 30, 60, 90, and 120 s during facemask ventilation. Results: After facemask ventilation for 120 s, gastric insufflation was detected in 24 children (45.3%) by ultrasonographic monitoring, and the antral CSA was significantly increased in groups P12 and P16. The Vt (mL/kg) of group P8 was significantly lower than the other two groups, and the probability of hypoventilation (Vt<6 mL/kg) was high which was 66.6%. After 120 s facemask ventilation, group P8 showed a certain CO2 accumulation for PETCO2 at (40.6±4.0) mmHg. Contrarily, group P16 showed excessive ventilation for PETCO2 at (23.6±1.4) mmHg. At the same time, the ETO2 of group P8 was lower than in groups P12 and P16 which had no significant difference. Conclusion: Ultrasonography can be well used in monitoring gastric insufflation related to facemask ventilation during induction of anesthesia. When PIP value is set as 12 mmHg, there was low incidence of gastric insufflation with adequate pulmonary ventilation in 2-4 years children.
