Anesthesia Intubation Complication, Surgery
Conditions
Keywords
Low Left Paratracheal esophagus Pressure, gastric insufflation, Echography, children, elective surgery, positive pressure ventilation
Brief summary
The use of cricoid pressure to prevent gastric aspiration or regurgitation in case of full stomach situation or emergency is still controversial in the adult population. Moreover this maneuver is no more recommended in children by some European pediatric anesthesia societies, because of a lack of evidence of its protective effect against gastric aspiration and its possible adverse effects. A new approach to occlude effectively the esophageal lumen has been recently described in adults and has shown its effectiveness to prevent gastric insufflation. But this maneuver has so far not been evaluated in the pediatric population and could be an alternative to prevent gastro-esophageal regurgitation and pulmonary aspiration in children
Interventions
OTHERMAVEPPIC: MAsk VEntilation with Paratracheal Pressure In Children
Pressure will be applied with two fingers in the area located between the trachea and the sternal head of the sternocleidomastoid muscle on the left side to compress the cervical esophagus. The force applied (after measuring the equivalent force applied on a precision scale) will be about 10 - 15 N. This force will be adapted according to the child's body weight : 10 N below 20 kgs and 15 N between 20 kgs and 40 kgs
Sponsors
University Hospital, Lille
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
2 Years to 10 Years
Healthy volunteers
No
Inclusion criteria
* Children from 2 to 10 years of age who benefit from general anesthesia with or without intubation * inhalation induction * elective surgery * ASA status 1 or 2 * consent of the child if he/she is able to express it * consent of both parents and/or legal guardians * socially insured
Exclusion criteria
* Child under 2 years old or \> 10 years * body weight is over 40 kgs * ASA status 3 or higher * Emergency surgery or unscheduled surgery * scheduled ENT or esogastric surgery * Achalasia of the esophagus or history of GERD pathology * History of esophageal surgery (NISSEN type) * BMI indexed to age and sex showing childhood obesity * Predictable mask ventilation difficulties * History of Tracheostomy * Child not insured by social security
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Presence of air artefacts during positive pressure ventilation as evaluated by simultaneous gastric ultrasonography | We will perfom a unique measurement of gastric air artefact by ultrasonography after 2 minutes of positive pressure ventilation. | Presence of antral and/or gastric air artefact described in ultrasonography. US will be perform during positive pressure mask ventilation. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| The verification of the actual position of the esophagus on the left side of the trachea at the place where LPPP will be applied (feasibility of LLPP) | Before the beginning of positive pressure ventilation during 1 minute | Left side of the trachea ultrasonography performed before positive pressure ventilation |
| The safety of the LLPP maneuver: absence of any significant compression of the adjacent vessels as measured by US. | Before the beginning of positive pressure ventilation and during 1 minute | Left side of the trachea ultrasonography performed before positive pressure ventilation |
| The expired tidal volume and peak inspiratory pressure as measured during PPV to evaluate any difficulty in mask ventilation induced by LLPP. | At the beginning of positive pressure ventilation and during two minutes | Expired tidal volume measured exhaled flow on anesthesia ventilator |
Countries
France
Outcome results
None listed