Two Modalities of Ventilation on the Occurrence of Respiratory Complications During Inhalational Anaesthetic Induction in Children

Comparison of Two MOdalities of VEntilation on the Occurrence of Respiratory Complications During Inhalational Anaesthetic Induction in Children: a Multicentre Randomised Controlled Trial.

Induction of anesthesia by inhalation is the most common method of induction (70% in France) for young children admitted for non-emergency surgery. It has the advantage of not requiring an intravenous line.

Serious respiratory adverse events such as laryngospasm or bronchospasm remain common in young children during anesthesia induction (approximately 4%) and can reach up to 30% when mild respiratory adverse events (coughing, desaturation < 95%, airway obstruction) are included.

Traditionally, inhalation induction is performed under spontaneous ventilation using the anesthesia ventilator circuit. However, modern ventilators offer the option of applying positive end-expiratory pressure (PEEP) and pressure support ventilation (PSV). Several physiological studies suggest that the use of PEEP + PSV during anesthesia may help maintain airway patency, minute ventilation, and functional residual capacity (FRC).

Our hypothesis is that administering PEEP + PSV at the time of induction may reduce the risk of respiratory complications.

The primary objective is to demonstrate that induction of anesthesia using PEP + PSV, compared with induction of anesthesia under spontaneous ventilation, reduces the risk of adverse respiratory events in children requiring general anesthesia with planned inhalational induction.

Inclusion Criteria:

• Child between 3 months and 6 years old
• Without significant comorbidity (ASA 1 or 2)
• Admitted for elective or emergency/urgent surgery under general anesthesia
• With induction of anaesthesia by inhalation by sevoflurane on the machine circuit
• With airway control by intubation tube or supraglottic device
• Consent of at least one parent or legal guardian

Exclusion Criteria:

• Children with severe upper respiratory tract infection (severe moist cough, fever and lethargy, oxygen requirement) in the last 7 days requiring intravenous induction or postpone of the surgery
• Thoracic surgery with selective control of intubation
• Criteria for difficult intubation or known history of difficult intubation
• Children with a contraindication to sevoflurane (ex: risk of malignant hyperthermia)
• Children asking for intravenous induction or requiring rapid sequence induction
• Children with significant cardiac disease (pulmonary hypertension, cyanotic heart disease,…)
• Children not affiliated or beneficiary of a health insurance system
• Children participating in other interventional research with an exclusion period still in progress at inclusion

Exclusion Criteria :

• Failure of venous access after 30 min or more than 5 attempts
• Parents' consent withdrawal