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

Eun Hee Kim, Sung Ae Cho, Pyoyoon Kang, In Sun Song, Sang Hwan Ji, Young Eun Jang, Ji Hyun Lee, Jin Tae Kim, Hee Soo Kim

Research output: Contribution to journalArticlepeer-review


Background: The use of cricoid compression to prevent insufflation remains controversial, and its use in children is limited. This study aimed to examine the effect of real-time ultrasound-guided esophageal compression on the prevention of gastric insufflation. Method: This prospective observational study was conducted with fifty children aged < 2 years undergoing general anesthesia. Patients were excluded if they were at an increased risk for gastric regurgitation or pulmonary aspiration. Following anesthetic induction under spontaneous breathing, ultrasound-guided esophageal compression was performed during pressure-controlled face-mask ventilation using a gradual increase in peak inspiratory pressure from 10 to 24 cm H2O to determine the pressure at which gastric insufflation occurred. The primary outcome was the incidence of gastric insufflation during anesthetic induction with variable peak inspiratory pressure after real-time ultrasound-guided esophageal compression was applied. Results: Data from a total of 42 patients were analyzed. Gastric insufflation was observed in 2 (4.7%) patients. All patients except one had their esophagus on the left side of the trachea. Applying ultrasound-guided esophageal compression did not affect the percentage of glottic opening scores (P = 0.220). Conclusions: The use of real-time ultrasound-guided esophageal compression pressure can aid preventing gastric insufflation during face-mask ventilation in children less than 2 years old. Trial registration: Clinicaltrials.gov identifier: NCT04645043.

Original languageEnglish
Article number257
JournalBMC Anesthesiology
Issue number1
StatePublished - Dec 2022


  • Cricoid compression
  • Esophagus
  • Pediatric patients
  • Ultrasonography


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