Inhalational versus Intravenous Induction of Anesthesia in Children with a High Risk of Perioperative Respiratory Adverse Events

Background Children routinely undergo inhalational induction of general anesthesia. Intravenous line placement typically occurs after induction of anesthesia and can be challenging, particularly in infants and young children. Aims We conducted a retrospective observational study to determine whether there was an association between clear liquid fasting time and the number of peripheral intravenous catheter insertion attempts in anesthetized children. The secondary aim was to identify factors associated with multiple attempts to insert intravenous lines. Methods After institutional research board approval, we retrieved a data set of all children between 0 months and 18 years who received general anesthesia at our hospital between January 1, 2016, and September 30, 2017. Data included age, gender, weight, race, ASA status, gestational age, number of peripheral intravenous catheter insertion attempts, any assistive device for insertion, and insertion site. Inclusion criteria were mask induction, ASA status 1 or 2, nonemergency, ambulatory surgical procedures, and placement of a single intravenous line during the anesthetic. Results A total of 9693 patients were included in the study. Of which 8869 patients required one insertion attempt and 824 underwent multiple insertion attempts. 50% of patients in the single insertion attempt group had clear liquid fasting time <6.9 hours compared to 51.8% of patients requiring multiple attempts. Logistic regression model adjusted for age, ASA status, gender, and BMI did not find an association between duration of clear liquid fasting time and rate of multiple insertion attempts for intravenous catheters (OR: 0.99, 95% CI: 0.98‐1.01, P = .47). Conclusion Clear liquid fasting time was not associated with multiple insertion attempts for intravenous line insertion in children receiving general anesthesia. Factors such as patient age, ethnicity, time of day of induction of anesthesia, and American Society of Anesthesiologists Physical Status classification show a greater association with the risk of multiple intravenous line insertion attempts.

Section: Introductionmentioning

confidence: 99%

Duration of preoperative clear fluid fasting and peripheral intravenous catheterization in children: A single‐center observational cohort study of 9693 patients

Gálvez

Simpao

et al. 2019

“…Some may cite recent work, suggesting that airway complications are lower when intravenous inductions are used in higher risk children, but the lower risk of respiratory adverse events in laryngeal mask cases found in that study does not help us decide how best to secure a difficult airway in the first instance.…”

Section: That Leads Us To the Safety Arguments…mentioning

confidence: 80%

Volatiles or TIVA: Which is the standard of care for pediatric airway procedures? A pro‐con discussion

Lauder

Thomas

Ungern‐Sternberg

et al. 2020

Anesthesia for pediatric airway procedures constitutes a true art form that requires training and experience. Communication between anesthetist and surgeon to establish procedure goals is essential in determining the most appropriate anesthetic management. But does the mode of anesthesia have an impact? Traditionally, inhalational anesthesia was the most common anesthesia technique used during airway surgery. Introduction of agents used for total intravenous anesthesia (TIVA) such as propofol, short‐acting opioids, midazolam, and dexmedetomidine has driven change in practice. Ongoing debates abound as to the advantages and disadvantages of volatile‐based anesthesia versus TIVA. This pro‐con discussion examines both volatiles and TIVA, from the perspective of effectiveness, safety, cost, and environmental impact, in an endeavor to justify which technique is the best specifically for pediatric airway procedures.

“…Other features of a DiVA child may include a documented history of multiple attempts for PIV access by experienced proceduralists, parent‐reported difficulty or a child with no obvious visible and palpable vein . Traditionally, anesthesiologists typically place PIVs following inhalational induction of anesthesia in children . Difficulty with placement of PIVs following inhalational induction may lead to prolonged times during which children are vulnerable to adverse airway events with delays in access to care, obtaining diagnosis, and initiating treatment .…”

Section: Introductionmentioning

confidence: 99%

“…Traditionally, anesthesiologists typically place PIVs following inhalational induction of anesthesia in children . Difficulty with placement of PIVs following inhalational induction may lead to prolonged times during which children are vulnerable to adverse airway events with delays in access to care, obtaining diagnosis, and initiating treatment . Furthermore, multiple attempts have been linked to increased patient discomfort, poor satisfaction, increased risk of complications, and increased use of a healthcare providers time performing the procedure in departments outside the operating room .…”

Section: Introductionmentioning

confidence: 99%

Ultrasound‐guided techniques for peripheral intravenous placement in children with difficult venous access

Munshey

Parra

McDonnell

et al. 2019

Peripheral intravenous placement in children can be challenging. Different techniques have been used to improve first pass success rates in children with known history of difficult venous access including surface landmarking, local warming, transillumination, ultrasonography, epidermal nitroglycerin, central venous access, intraosseous placement, and venous cutdown. Among these, ultrasound guidance has garnered the most interest among anesthesiologists. The cumulative literature surrounding the utility of ultrasound‐guided peripheral intravenous placement in children with and without difficult venous access has shown mixed results. Literature on the utility of ultrasound guidance for peripheral intravenous placement in children under deep sedation or anesthesia is limited but encouraging. This review summarizes the overall evidence for ultrasound‐guided peripheral intravenous placement in children with difficult venous access under deep sedation or general anesthesia. Furthermore, five subtly varying approaches to ultrasound‐guided peripheral intravenous placement with their advantages and disadvantages will be discussed. One of these five approaches is Dynamic Needle Tip Positioning. Utilizing a short axis out of plane ultrasound view, this promising technique allows for accurate needle tip localization and may increase the success rate of peripheral intravenous placement, even in small children, under deep sedation, or general anesthesia.