Journal of Anesthesia

, Volume 33, Issue 1, pp 33–39 | Cite as

Peak airway pressure is lower during pressure-controlled than during manual facemask ventilation for induction of anesthesia in pediatric patients—a randomized, clinical crossover trial

  • Ulrich Goebel
  • Stefan Schumann
  • Steffen WirthEmail author
Original Article



Facemask ventilation during the induction of general anesthesia in paediatric patients remains a challenge as it may result in hypoxic conditions and gastric insufflation with subsequent regurgitation and aspiration. So far, it is unclear if pressure-controlled or manual facemask ventilation is preferable in children. We hypothesized that pressure-controlled ventilation in apnoeic children results in lower peak airway pressure and flow rates compared to manual ventilation at comparable respiratory rates and tidal volumes.


Sixty-two lung-healthy children undergoing scheduled ear-nose-throat surgery were included in the study. After the induction of anesthesia, the patient’s lungs were consecutively ventilated via a facemask in either manual or pressure-controlled mode, in randomized order. The primary outcome measure was peak airway pressure. Secondary outcome measures included positive end-expiratory pressure, airway compliance, tidal volume and airway flow.


Data of 52 patients could be analyzed. Pressure-controlled ventilation resulted in a lower mean and peak inspiratory pressure (both p < 0.001), airway pressure amplitude (p = 0.01) and inspiratory peak flow rate (p = 0.005) compared to manual ventilation. The ratio of inspiration to expiration time was lower in pressure-controlled ventilation compared to manual ventilation (p < 0.001).


Pressure-controlled facemask ventilation during induction of anesthesia in pediatric patients results in lower airway pressure, and lower flow rates compared to manual ventilation, at comparable tidal and minute volumes.


Pressure support ventilation Pediatric anesthesia Gastric regurgitation Patient safety 



The authors like to thank Helen Engelstaedter for language editing, Daniel Steinmann for reviewing the manuscript and technical support, Christian Göttel for help with data collection and Manfred Olschewski for support in statistical analyses. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

None of the authors has any conflict of interest.


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Copyright information

© Japanese Society of Anesthesiologists 2018

Authors and Affiliations

  1. 1.Department of Anesthesiology and Critical Care, Medical CenterUniversity of FreiburgFreiburgGermany
  2. 2.Faculty of MedicineUniversity of FreiburgFreiburgGermany

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