Hasan Abm Kamrul, Sivasankar Raman, Nair Salil G, Hasan Wamia U, Latif Zulaidi
Department of Anesthesiology, RIPAS Hospital, Bandar Seri Begawan, Brunei Darussalam.
Department of Chemical Biology, University of British Columbia, Vancouver, BC, Canada.
Paediatr Anaesth. 2018 Feb;28(2):179-183. doi: 10.1111/pan.13308. Epub 2018 Jan 8.
Intravenous cannulation is usually done in children after inhalational induction with volatile anesthetic agents. The optimum time for safe intravenous cannulation after induction with sevoflurane, oxygen, and nitrous oxide has been studied in premedicated children, but there is no information for the optimum time for cannulation with inhalational induction in children without premedication.
The aim of this study was to determine the optimum time for intravenous cannulation after the induction of anesthesia with sevoflurane, oxygen, and nitrous oxide in children without any premedication.
This is a prospective, observer-blinded, up-and-down sequential allocation study in unpremedicated ASA grade 1 children aged 2-6 years undergoing elective dental surgery. Intravenous cannulation was attempted after inhalational induction with sevoflurane, oxygen, and nitrous oxide. The timing of cannulation was considered adequate if there was no movement, coughing, or laryngospasm. The cannulation attempt for the first child was set at 4 minutes after the loss of eyelash reflex and the time for intravenous cannulation was determined by the up-and-down method using 15 seconds as step size. Probit test was used to analyze the up-down sequences for the study.
The adequate time for effective cannulation after induction with sevoflurane, oxygen, and nitrous oxide in 50% and 95% of patients was 53.02 seconds (95% confidence limits, 20.23-67.76 seconds) and 87.21 seconds (95% confidence limits, 70.77-248.03 seconds), respectively.
We recommend waiting for 1 minute 45 seconds (105 seconds) after the loss of eyelash reflex before attempting intravenous cannulation in pediatric patients induced with sevoflurane, oxygen, and nitrous oxide without any premedication.
儿童静脉置管通常在吸入挥发性麻醉剂诱导后进行。已对使用咪达唑仑预处理的儿童在七氟醚、氧气和氧化亚氮诱导后进行安全静脉置管的最佳时间进行了研究，但对于未使用预处理的儿童吸入诱导后置管的最佳时间尚无相关信息。
本研究的目的是确定在未使用任何预处理的儿童中，七氟醚、氧气和氧化亚氮麻醉诱导后静脉置管的最佳时间。
这是一项前瞻性、观察者盲法、上下顺序分配研究，研究对象为2-6岁未使用预处理的美国麻醉医师协会（ASA）1级择期牙科手术患儿。在七氟醚、氧气和氧化亚氮吸入诱导后尝试进行静脉置管。如果没有肢体活动、咳嗽或喉痉挛，则认为置管时机合适。第一个儿童的置管尝试设定在睫毛反射消失后4分钟，静脉置管时间通过上下法确定，步长为15秒。使用概率单位检验分析该研究的上下顺序。
七氟醚、氧气和氧化亚氮诱导后，50%和95%的患者有效置管的合适时间分别为53.02秒（95%置信区间，20.23-67.76秒）和87.21秒（95%置信区间，70.77-248.03秒）。
我们建议，对于未使用任何预处理、采用七氟醚、氧气和氧化亚氮诱导的儿科患者，在睫毛反射消失后等待1分45秒（105秒）再尝试静脉置管。
