Who needs an IV? Retrospective service analysis in a tertiary pediatric hospital

The question if it is possible and safe to anesthetize children for short procedures without intravenous (IV) access provokes strong opinions among pediatric anesthetists. However, only limited data are available to support either side of the arguments. This pediatric university hospital provides anesthesia to a community dental service, led by staff anesthesiologists. A rapid turnover system based on inhalational induction and maintenance of anesthesia without mandatory IV access has been employed since 2005.

A retrospective service analysis was performed to identify the incidence of adverse anesthesia events.

A total of 6440 children with an average (± SD) age of 8.1 (± 4.1) years and weight of 29.6 (± 13.5) kg were cared for over the 5-year period. The total number of children refusing to undergo inhalational induction was 81 (1.26%) and 19 (0.3%) elected for an IV induction. One-third received cannulation for delivery of IV analgesia. There were no adverse anesthesia events requiring emergency cannulation and/or intubation over the 5-year period.

This service review indicates that general anesthesia for outpatient dental anesthesia may be safely performed without mandatory IV access. The technique employed in this center emphasizes the need for the clinician to primarily concentrate on pediatric airway management in a safe environment with experienced assistance. It supports the hypothesis that instrumentation of the airway (insertion of laryngeal mask airway) can be satisfactorily achieved without prior IV access.