Real-time Detection of Gastric Insufflation Related to Facemask Pressure-controlled Ventilation Using Ultrasonography of the Antrum and Epigastric Auscultation in Nonparalyzed Patients A Prospective, Randomized, Double- blind Study

被引:102
作者
Bouvet, Lionel [1 ,2 ]
Albert, Marie-Laure [2 ,3 ]
Augris, Caroline [2 ,3 ]
Boselli, Emmanuel [2 ,3 ]
Ecochard, Rene [4 ,5 ]
Rabilloud, Muriel [4 ,5 ]
Chassard, Dominique [6 ,7 ]
Allaouchiche, Bernard [2 ,3 ]
机构
[1] Univ Lyon, INSERM, UMR 865, Lyon, France
[2] Hosp Civils Lyon, Hop Edouard Herriot, Dept Anesthesia & Intens Care, Lyon, France
[3] Univ Lyon, Lyon, France
[4] Univ Lyon, CNRS, UMR 5558, Lyon, France
[5] Hosp Civils Lyon, Dept Biostat, Lyon, France
[6] Univ Lyon, Bron, France
[7] Hosp Civils Lyon, Femme Mere Enfant Hosp, Dept Anesthesia & Intens Care, Bron, France
关键词
LOWER ESOPHAGEAL SPHINCTER; PARTIALLY PARALYZED HUMANS; RAPID-SEQUENCE INDUCTION; LARYNGEAL MASK AIRWAY; PULMONARY ASPIRATION; INTUBATING CONDITIONS; GENERAL-ANESTHESIA; MUSCLE-RELAXANTS; PANCURONIUM; ATRACURIUM;
D O I
10.1097/ALN.0000000000000094
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Background: The authors sought to determine the level of inspiratory pressure minimizing the risk of gastric insufflation while providing adequate pulmonary ventilation. The primary endpoint was the increase in incidence of gastric insufflation detected by ultrasonography of the antrum while inspiratory pressure for facemask pressure-controlled ventilation increased from 10 to 25 cm H2O. Methods: In this prospective, randomized, double-blind study, patients were allocated to one of the four groups (P10, P15, P20, and P25) defined by the inspiratory pressure applied during controlled-pressure ventilation: 10, 15, 20, and 25 cm H2O. Anesthesia was induced using propofol and remifentanil; no neuromuscular-blocking agent was administered. Once loss of eyelash reflex occurred, facemask ventilation was started for a 2-min period while gastric insufflation was detected by auscultation and by real-time ultrasonography of the antrum. The cross-sectional antral area was measured using ultrasonography before and after facemask ventilation. Respiratory parameters were recorded. Results: Sixty-seven patients were analyzed. The authors registered statistically significant increases in incidences of gastric insufflation with inspiratory pressure, from 0% (group P10) to 41% (group P25) according to auscultation, and from 19 to 59% according to ultrasonography. In groups P20 and P25, detection of gastric insufflation by ultrasonography was associated with a statistically significant increase in the antral area. Lung ventilation was insufficient for group P10. Conclusion: 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)
引用
收藏
页码:326 / 334
页数:9
相关论文
共 41 条
[1]   High-resolution solid-state manometry of the effect of rocuronium on barrierpressure [J].
Ahlstrand, R. ;
Thorn, S-E. ;
Wattwil, M. .
ACTA ANAESTHESIOLOGICA SCANDINAVICA, 2011, 55 (09) :1098-1105
[2]   CONTROLLING THE FALSE DISCOVERY RATE - A PRACTICAL AND POWERFUL APPROACH TO MULTIPLE TESTING [J].
BENJAMINI, Y ;
HOCHBERG, Y .
JOURNAL OF THE ROYAL STATISTICAL SOCIETY SERIES B-STATISTICAL METHODOLOGY, 1995, 57 (01) :289-300
[3]   MEASUREMENT OF GASTRIC-EMPTYING TIME BY REAL-TIME ULTRASONOGRAPHY [J].
BOLONDI, L ;
BORTOLOTTI, M ;
SANTI, V ;
CALLETTI, T ;
GAIANI, S ;
LABO, G .
GASTROENTEROLOGY, 1985, 89 (04) :752-759
[4]   Optimal remifentanil dosage for providing excellent intubating conditions when co-administered with a single standard dose of propofol [J].
Bouvet, L. ;
Stoian, A. ;
Rimmele, T. ;
Allaouchiche, B. ;
Chassard, D. ;
Boselli, E. .
ANAESTHESIA, 2009, 64 (07) :719-726
[5]  
Bouvet L, ANN M AM SOC AN OCT
[6]  
Bouvet L, 2008, CAN J ANAESTH, V55, P674, DOI 10.1007/BF03017743
[7]   Clinical Assessment of the Ultrasonographic Measurement of Antral Area for Estimating Preoperative Gastric Content and Volume [J].
Bouvet, Lionel ;
Mazoit, Jean-Xavier ;
Chassard, Dominique ;
Allaouchiche, Bernard ;
Boselli, Emmanuel ;
Benhamou, Dan .
ANESTHESIOLOGY, 2011, 114 (05) :1086-1092
[8]   Could a single standardized ultrasonographic measurement of antral area be of interest for assessing gastric contents? A preliminary report [J].
Bouvet, Lionel ;
Miquel, Anne ;
Chassard, Dominique ;
Boselli, Emmanuel ;
Allaouchiche, Bernard ;
Benhamou, Dan .
EUROPEAN JOURNAL OF ANAESTHESIOLOGY, 2009, 26 (12) :1015-1019
[9]   Reliability of epigastric auscultation to detect gastric insufflation [J].
Brimacombe, J ;
Keller, C ;
Kurian, S ;
Myles, J .
BRITISH JOURNAL OF ANAESTHESIA, 2002, 88 (01) :127-129
[10]   Ultrasound evaluation of the nasogastric tube position in prehospital [J].
Brun, P. -M. ;
Chenaitia, H. ;
Bessereau, J. ;
Leyral, J. ;
Barberis, C. ;
Pradel-Thierry, A. -L. ;
Stephan, J. ;
Benner, P. ;
Querellou, E. ;
Topin, F. .
ANNALES FRANCAISES D ANESTHESIE ET DE REANIMATION, 2012, 31 (05) :416-420