Pediatric Anesthesia Article of the Day

Monday, February 22, 2021

Good morning, Happy Monday, and Happy Birthday George Washington!

Jung Oh E, et al. Evaluation of the factors related to difficult ultrasound-guided radial artery catheterization in small children: A prospective observational study. Acta Anaesthesiol Scand. 2021 Feb;65(2):203–212. doi: 10.1111/aas.13704. Epub 2020 Sep 2. PMID: 32929724

I enjoyed this investigation of factors that hinder ultrasound-guided radial artery cannulation in infants that was published in the February edition of Acta Anaesthesiologica Scandinavica. The use of ultrasound to aid in performing radial artery cannulation has become the standard of care in many centers throughout the world. Jung Oh et al, from Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea, prospectively examined these procedures in infants under two years of age. All cannulations were attempted by the first author with a 24-gauge angiocatheter. The outcome variables included first attempt success rate, procedure failure (defined as lack of success at the 10-minute mark), and total procedure time, which took into account the preparation phase. Over an approximate 1-year period, 183 children were enrolled. The first-attempt success rate was 66%, and overall success was 90%. Multivariate analysis that adjusted for confounding variables demonstrated that a radial artery cross-sectional area of ≤1 mm2 (OR = 5.26; 95% CI, 2.48–11.18; P < .0001) and the presence of an anomalous radial artery branch (OR = 3.37; 95% CI, 1.43–7.95; P = .005) were independent predictors of the first-attempt cannulation failure. (patients with a radial artery branch demonstrated a significantly smaller cross-sectional area compared with those without a branch). The authors also found that smaller infants naturally had smaller radial artery cross-sectional areas. Anomalous radial artery branches were identified in 19.7% of patients and majority of them were accompanied by by congenital cardiovascular diseases (31/36, 86.1%).

Although many of you are probably thinking these results were quite predictable (and they were!) I thought the article was useful because it gave me a frame of reference. If an experienced insertioner like Dr. Jung Oh had relative difficulty cannulating arteries with a cross-sectional area of ≤1 mm2, then I am also more likely to have difficulty, and I will search for an alternative cannulation site, such as a more proximal portion of the same artery, or the radial artery of the opposite wrist, if available. Because of these results I am now much more likely to search for and examine the characteristics of the radial artery before going to the trouble of prepping and draping the area.

“Let’s be careful out there”, Sgt. Phillip Esterhaus, Hill Street Blues

Remember to check out Rob Greenberg’s insane website pedsanesthesia.net — it has everything!

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Pediatric Anesthesia Article of the Day

Ron Litman, Pediatric anesthesiologist, Children’s Hospital of Philadelphia, Med Director, ISMP, Past Chair FDA AADPAC