Efficient Intravenous Access Without Distress

Ekbom, Karl; Kalman, Sigridur; Jakobsson, Jan; Marcus, Claude

doi:10.1001/archpediatrics.2011.56

Cited by 24 publications

(8 citation statements)

References 44 publications

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“…access in distressed children with chronic diseases or obesity [16,22]. This was confirmed in this study when the levels of stress hormones were correlated with the evaluation of the procedure.…”

Section: Discussionsupporting

confidence: 74%

“…access were seen when all children and treatments were included. Post hoc analyses demonstrated a significant correlation between children’s evaluations of the procedure and mean values of cortisol (r = –0.53), growth hormone (r = –0.52), and norepinephrine (r = –0.5) in children treated with 10% N 2 O, i.e., within the group with the weakest pain relief [22]. …”

Section: Resultsmentioning

confidence: 99%

“…The effect on pain and i.v. access as well as the double-blind design has recently been published [22]. The study design was a prospective, double-blind, randomized, controlled study of 90 children, 60 obese [23] and 30 growth retarded (GR) [24], aged 5–18 years, randomly allocated to 1 of 3 groups and given different types of treatments to reduce problems during i.v.…”

Section: Methodsmentioning

confidence: 99%

“…Midazolam has been shown to reduce the cortisol and insulin secretions and also to regulate growth hormone secretion [20,21]. We have recently compared the efficiency of midazolam and N 2 O in a double-blind study, and we could demonstrate a higher success rate, shorter total procedure time, and higher scores of satisfaction after 50% N 2 O [22]. …”

Section: Introductionmentioning

confidence: 99%

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Effects of Midazolam and Nitrous Oxide on Endocrine and Metabolic Measurements in Children

Ekbom¹,

Kalman

Jakobsson

et al. 2012

Horm Res Paediatr

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Objective: Pain, stress as well as drugs may affect metabolic and endocrine measurements, especially in stressed children. The aim was to study how release of glucose and stress hormones are affected when procedural sedation with nitrous oxide or midazolam are used for establishing intravenous access in obese and lean children. Methods: In a prospective, double-blind, randomized study 90 children, 60 obese and 30 growth-retarded (GR), aged 5–18 years, with reported anxiety or difficulties connected with i.v. access, were randomized to 1 of 3 groups: oral midazolam (0.3 mg/kg, max. 15 mg), 50% nitrous oxide (N₂O), and 10% N₂O. In addition, all children received anesthesia cream (EMLA®) locally 1 h before i.v. access. Blood samples were drawn at 4 time points during 30 min after establishing venous access and, when feasible, after 24 h. The 24-hour sample was regarded as obtained during unstressed condition. The effect of procedural sedation was analyzed. Children’s evaluations of pain (Numeric Rating Scale) and procedure (Likert Scale) were correlated with mean values of cortisol and glucose after i.v. access. For the metabolic and hormone control measurements, 60 children aged 4–18 years (40 obese and 20 GR) served as controls. These children underwent a 24-hour blood sampling and did not receive sedation. The control samples were drawn 10–12 h after i.v. access. Results: After midazolam, significantly lower cortisol levels were found compared to both 50% N₂O and 10% N₂O and to unstressed controls. The growth hormone levels decreased with time in the midazolam group compared to 50 and 10% N₂O, where the effect of time was reversed. Glucose levels among GR children increased from 0 to 30 min, whereas the opposite was found in obese children regardless of treatment. A post hoc analysis demonstrated significant correlations between children’s evaluations of the procedure and mean values of cortisol (r = –0.53), growth hormone (r = –0.52), and norepinephrine (r = –0.5) in children treated with a very low dose of N₂O (10%). Conclusions: When sedation is insufficient during i.v. access, and blood sampling pain and stress affect hormone values, treatment with N₂O or midazolam influence the glucose and stress hormone levels differently. These differences need to be accounted for when results are used for diagnosis and clinical decisions.

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Section: Discussionsupporting

confidence: 74%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Effects of Midazolam and Nitrous Oxide on Endocrine and Metabolic Measurements in Children

Ekbom¹,

Kalman

Jakobsson

et al. 2012

Horm Res Paediatr

Self Cite

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show abstract

“…The children, parents, and nurses were unaware of the randomization codes until data entry was completed. The procedure has been described in detail elsewhere [ 21 ].…”

Section: Methodsmentioning

confidence: 99%

Pain and Stress Response during Intravenous Access in Children with Congenital Adrenal Hyperplasia: Effects of EMLA and Nitrous Oxide Treatment

Ekbom

2017

Pain Research and Treatment

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Background Congenital adrenal hyperplasia (CAH) is an endocrine condition that requires regularly blood samples for optimal treatment. The management of CAH in children is complex when intravenous access is one of the most stressful procedures for children. The purpose of this pilot study was to investigate the effects of nitrous oxide inhalation (N2O) in combination with cutaneous application of local anesthetics (EMLA) for improving intravenous access in children with CAH. Method Ten children (7–14 years) were studied. The children received two intravenous procedures: one with EMLA and one with EMLA + N2O. The order of priority was randomized. The outcomes were the children's pain experience (0–10) and an evaluation of satisfaction (1–5) after the procedure. Heart rate, blood pressure, saturation, and analyses of 17-hydroxyprogesterone (17-OHP), norepinephrine, and glucose were analyzed. Results Higher pain scores, heart rate, and glucose levels were reported after EMLA, compared to EMLA + N2O, but 17-OHP levels remained unchanged. The children's satisfaction with the intravenous procedure was more positive for EMLA + N2O. Conclusions EMLA + N2O offers the possibility of improving the intravenous procedure for anxious children with CAH. Although the quality of care was better with N2O treatment, it was not possible to demonstrate that this is a prerequisite for valid 17-OHP measurements.

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Operative Preparation of the Patient for Heart Surgery: Airway and Ventilation, Vascular Access and Monitoring

Ullah

Zabala

2013

Pediatric and Congenital Cardiology, Cardiac Surgery and Intensive Care

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Efficient Intravenous Access Without Distress

Abstract: To determine whether treatment with midazolam or with nitrous oxide is more efficient in facilitating intravenous (IV) access in lean and obese children and adolescents. Design: A prospective, double-blind, randomized trial of 90 children and adolescents.

Cited by 24 publications

References 44 publications

Effects of Midazolam and Nitrous Oxide on Endocrine and Metabolic Measurements in Children

Effects of Midazolam and Nitrous Oxide on Endocrine and Metabolic Measurements in Children

Pain and Stress Response during Intravenous Access in Children with Congenital Adrenal Hyperplasia: Effects of EMLA and Nitrous Oxide Treatment

Operative Preparation of the Patient for Heart Surgery: Airway and Ventilation, Vascular Access and Monitoring

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