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Anesthesia through an intraosseous line using an 18-gauge intravenous needle for emergency pediatric surgery

Riyadh Khudeir Hamed1, Sharon Hartmans, Marianne Gausche-Hill

  • 1Department of Pediatric and Neonatal Anesthesia, Children's Welfare Teaching Hospital, Medical City, Baghdad, Iraq.

Journal of Clinical Anesthesia
|September 7, 2013
PubMed

Insights

Intraosseous (IO) access using an 18-gauge needle provided rapid anesthesia delivery in critically ill infants when other IV access failed. This simple technique achieved 100% success with minor complications, proving effective for emergency pediatric surgery.

Area of Science:

  • Pediatric Anesthesiology
  • Emergency Medicine
  • Vascular Access Techniques

Background:

  • Establishing vascular access in critically ill infants for emergency surgery can be challenging.
  • Peripheral or central venous access may not be obtainable or may fail during procedures.
  • Intraosseous (IO) access offers an alternative route for fluid and medication delivery.

Purpose of the Study:

  • To evaluate the success and complication rates of intraosseous (IO) access for anesthesia delivery in infants.
  • To assess the efficacy of using a standard 18-gauge intravenous (IV) needle for IO access.
  • To describe the application of IO access in critically ill infants undergoing emergency surgery.

Main Methods:

  • A prospective study was conducted at Children's Welfare Teaching Hospital, Baghdad, Iraq.
  • 30 critically ill infants (3 weeks to 16 months) requiring emergency surgery had IO access established when peripheral/central access failed.
  • An 18-gauge IV needle was inserted into the proximal tibia and connected for anesthesia delivery.

Main Results:

  • Intraosseous access was successfully established in 100% (30/30) of infants within minutes.
  • 90% of patients recovered well postoperatively, with 10% requiring pediatric intensive care unit (PICU) admission due to their critical condition.
  • Minor complications (10%) included extravasation (2 cases) and cellulitis (1 case).

Conclusions:

  • The intraosseous route is a successful and rapid method for anesthesia delivery, induction, and maintenance in critically ill infants undergoing emergency surgery.
  • Using a simple 18-gauge IV needle for IO access is effective and associated with few complications.
  • IO access is a valuable alternative when standard vascular access routes are unavailable or have failed.
Abstract

Keywords:
Anesthesia: intraosseous routeCatheterizationEmergency surgeryPediatrics

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