Research Institute, BC Children's Hospital, Vancouver, BC, Canada.
Department of Biomedical Engineering, Hamburg University of Applied Sciences, Hamburg, Germany.
Paediatr Anaesth. 2020 Aug;30(8):874-884. doi: 10.1111/pan.13936. Epub 2020 Jun 25.
Approaches to pediatric induction of anesthesia vary widely. While oral sedative premedication and inhalational induction are common, total intravenous anesthesia is becoming increasingly popular. Total intravenous anesthesia without anxiolytic premedication, which is the most commonly used technique in our hospital, requires intravenous (IV) cannula placement in an awake child.
To quantify the success rate of IV cannula placement in 1 or 2 attempts and to identify success factors and barriers.
With ethical approval and written informed consent from participating anesthesiologists, a prospective audit of IV cannulation was undertaken over a 1-month period. The attending anesthesiologist captured basic demographics, IV insertion characteristics, setting, distraction techniques, the behavior of the child, number of attempts, and success/failure. A logistic regression model for successful IV cannulation was created. Anesthesiologists and procedural suite nurses participated in semi-structured interviews to identify success factors, barriers, and teaching approaches.
Data from 984 cases were analyzed. IV induction was planned in 562 cases, and IV cannulation was successful in 90% of these patients. Anxiolytic premedication was given in 6% of cases. Observations indicated that 64% of children were pain- and reaction-free, and 90% experienced minimal or no reaction. Predictors for success included older child's age and child behavior at first encounter. Qualitative interview data from 13 participants suggested success factors included effective distraction, preparing the family for IV induction, parental presence, support of the operating room team, effective use of local analgesic cream, adapting the approach to the individual child, and the anesthesiologist's efficiency. Barriers included needle phobia, uncooperative child, anxious parents, ineffective use of analgesic cream, and unfavorable anatomy. Distraction techniques varied by age and developmental stage of the child.
Cannulation for planned IV induction is feasible for most children, enabling increased use of total intravenous anesthesia as an institutional anesthetic strategy.
小儿麻醉诱导方法差异较大。虽然口服镇静术前用药和吸入诱导较为常见，但全凭静脉麻醉越来越受欢迎。在我们医院，最常用的技术是在清醒的儿童中进行无镇静药预给药的全凭静脉麻醉，这需要在静脉（IV）内放置导管。
量化 1 或 2 次尝试中 IV 导管放置的成功率，并确定成功因素和障碍。
在伦理批准和参与麻醉师书面知情同意的情况下，在 1 个月的时间内对 IV 置管进行了前瞻性审核。主治麻醉师记录了基本人口统计学资料、IV 插入特征、置管环境、分散注意力的技术、儿童的行为、尝试次数以及成功/失败情况。建立了 IV 置管成功的逻辑回归模型。麻醉师和程序套房护士参与了半结构化访谈，以确定成功因素、障碍和教学方法。
分析了 984 例数据。计划在 562 例患者中进行 IV 诱导，其中 90%的患者 IV 插管成功。6%的病例给予了镇静药。观察表明，64%的儿童无痛且无反应，90%的儿童反应轻微或无反应。成功的预测因素包括儿童年龄较大和首次接触时的行为。来自 13 名参与者的定性访谈数据表明，成功因素包括有效的分散注意力、为 IV 诱导做好家庭准备、父母在场、手术团队的支持、局部镇痛乳膏的有效使用、根据个体儿童的情况调整方法、以及麻醉师的效率。障碍包括针恐惧症、不合作的儿童、焦虑的父母、镇痛乳膏使用无效、以及不利的解剖结构。分散注意力的技术因儿童的年龄和发育阶段而异。
对于大多数儿童来说，计划进行 IV 诱导的置管是可行的，这使得全凭静脉麻醉作为一种机构麻醉策略得到更广泛的应用。
