Department of Anesthesiology, First Hospital of Jilin University, Changchun, Jilin, China.
Anesthesiology. 2023 May 1;138(5):497-507. doi: 10.1097/ALN.0000000000004534.
Radial artery cannulation in young children is challenging. A single-operator laser-assisted ultrasound-guidance system was invented to project the path of the target artery on the skin surface. The hypothesis was that this system would improve the first-attempt success rate of radial arterial cannulation in young pediatric patients relative to traditional ultrasound guidance.
This single-center, prospective, parallel-group, randomized controlled study enrolled pediatric patients (n = 80, age less than 2 yr) 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.
In total, 80 children were included in the analysis. The first-attempt success rate in the single-operator laser-assisted ultrasound-guidance group (36 of 40 [90%]) was significantly greater than that in the traditional ultrasound-guidance group (28 of 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 of 40, 3%) was significantly lower than that in the traditional ultrasound-guidance group (11 of 40, 28%; P = 0.002). Regarding the initial needle-tip position after skin puncture, the 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.
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 2 yr by projecting the path of the artery on the skin and provides better procedural conditions (stable ultrasound probe).
在幼儿中进行桡动脉插管具有挑战性。一种单操作者激光辅助超声引导系统被发明出来，以将目标动脉的路径投影到皮肤表面。假设该系统将提高小儿患者桡动脉插管的首次尝试成功率，优于传统超声引导。
这项单中心、前瞻性、平行组、随机对照研究纳入了 80 名（年龄小于 2 岁）需要在全身麻醉下进行桡动脉插管的儿科患者。参与者被随机分为传统超声引导组或单操作者激光辅助超声引导组。在诱导全身麻醉后，由两名有经验的操作者进行超声引导下桡动脉插管。主要结局是首次尝试的成功率。次要结局包括首次尝试成功的操作时间、中值首次尝试率、首次针尖位置和平均调整次数。
共有 80 名儿童纳入分析。单操作者激光辅助超声引导组（40 例中的 36 例 [90%]）的首次尝试成功率显著高于传统超声引导组（40 例中的 28 例 [70%]；绝对差异 20%[95%CI，2.3%至 36.6%]；P=0.025）。单操作者激光辅助超声引导组首次尝试成功的操作时间中位数明显短于传统超声引导组（31 秒[27，36 秒]与 46 秒[39，52 秒]；P<0.001）。单操作者激光辅助超声引导组（1 例[3%]）血肿的发生率明显低于传统超声引导组（11 例[28%]；P=0.002）。在皮肤穿刺后的初始针尖位置方面，中位数评分（4[3，4]与 2[2，3]；P<0.001）；位置 3、4 或 5（38[95%]与 13[33%]；P<0.001）；和位置 4 或 5（26[65%]与 5[13%]；P<0.001）均有利于单操作者激光辅助超声引导。
与传统超声引导相比，单操作者激光辅助超声引导系统是一种有用的附加手段，可增强小儿（年龄小于 2 岁）桡动脉插管的首次尝试成功率。它通过将动脉路径投影到皮肤上来提供更好的手术条件（稳定的超声探头），从而提高桡动脉插管的首次尝试成功率。
