Comparison of Single-operator Laser-assisted Ultrasound-guided Radial Arterial Cannulation in Young Children with Traditional Ultrasound Guidance: A Randomized Clinical Trial

Abstract

Background Radial artery cannulation in young children is challenging. Here, we invented a single-operator laser-assisted ultrasound-guidance system projecting the path of the target artery on the skin surface and hypothesized that this system would improve the first-attempt success rate of radial arterial cannulation in young pediatric patients relative to traditional ultrasound guidance. Methods This single-center, prospective, parallel-group, randomized controlled study enrolled pediatric patients (n = 80, age less than two years) requiring radial artery cannulation during general anesthesia. The participants were randomized into the traditional ultrasound-guidance group or the single-operator laser-assisted ultrasound-guidance group. After inducing general anesthesia, ultrasound-guided radial artery cannulation was performed by two experienced operators. The primary outcome was the first-attempt success rate. The secondary outcomes included the procedure time to success within the first attempt, midmost rate of first attempt, first needle-tip position, and average number of adjustments. Results In total, 80 children were included in the analysis. The first-attempt success rate in the single-operator laser-assisted ultrasound-guidance group (36/40 [90%]) was significantly greater than that in the traditional ultrasound-guidance group (28/40 [70%]; absolute difference 20% (95%CI: 2.3 % to 36.6%), P = 0.025). The median procedure time to success within the first attempt was shorter in the single-operator laser-assisted ultrasound-guidance group compared with the traditional ultrasound-guidance group (31 s [27, 36 s] vs. 46 s [39, 52 s]); P < 0.001). The incidence of hematoma in the single-operator laser-assisted ultrasound-guidance group (1/40, 3%) was significantly lower than that in the traditional ultrasound-guidance group (11/40, 28%; P = 0.002). Regarding the initial needle-tip position after skin puncture, median score (4 [3,4] vs. 2 [2,3]; P < 0.001), position = 3, 4, or 5 (38 [95%] vs. 13 [33%]; P < 0.001), and position = 4 or 5 (26 [65%] vs. 5 [13%]; P < 0.001) were all in favor of single-operator laser-assisted ultrasound guidance. Conclusions Compared with traditional ultrasound guidance, the single-operator laser-assisted ultrasound-guided system is a useful add-on to the ultrasound dynamic needle-tip puncture technique. It improves the first-attempt success rate of radial artery cannulation in children younger than two years by projecting the path of the artery on the skin and provides better procedural conditions (stable ultrasound probe).

Laser-assisted Pediatric Radial Artery Cannulation: Comment

“…They used laser-assisted ultrasound guidance to project the path of the target artery onto the skin surface, improving the speed and the first-attempt success rate of radial artery cannulation in children less than 2 yr old. 1 Although their findings have potential clinical implications, we observed several unaddressed issues in their study.…”

“…W e thank Lyu et al 1 for their interest and their comments on our research. 2 The concerns you raised are indeed among the most critical aspects considered during the research design and experiment process.…”

“…T he recent release of the "American Society of Anesthesiologists Consensus-Based Guidance on Preoperative Management of Patients (Adults and Children) on Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists" was timely and relevant. 1 These medications delay gastric emptying and have resulted in significant complications for patients undergoing anesthesia. [2][3][4] These effects on gastric emptying have consistently been demonstrated in studies using the gold standard examination, scintigraphy.…”

Laser-assisted Pediatric Radial Artery Cannulation: Reply

“…However, recent literature 5 suggests that a modified long-axis in-plane approach offers additional benefits with a lower incidence (5%) of posterior wall puncture than reported (10%) in this study. 1 We believe that a combined short-and modified long-axis approach would yield optimal success.…”

“…W e have read with great interest the article by Hou et al. 1 in the May issue of Anesthesiology. They used laser-assisted ultrasound guidance to project the path of the target artery onto the skin surface, improving the speed and the first-attempt success rate of radial artery cannulation in children less than 2 yr old.…”