Anesthesia Discussion > Pediatric Anesthesia
Inhalational induction and intubation BEFORE IV
John Farnsworth:
I trained in the UK and then worked for 1 year in Boston, USA. I was surprised at how different some things were. The most striking difference in clinical practice which I must admit I have not imported back to the UK is the American practice of doing an inhalational induction in a child, then proceding to secure the airway (either with an LMA or ETT) BEFORE obtaining IV access.
Where I trained, this would be grounds for failing the Finals. What would happen (I can hear the examiner ask) if after induction an one attempt at intubation, the child laryngospams before IV access is obtained?
I know the stock answers: children are almost always easy to intubate, IM sux, CPAP.
Is this common practice in the USA? Or was it just a regional variant?
Igor Bulatov:
I don't think intubation before IV is a standard of practice in pediatric anesthesiology in the US,but its totally acceptable especially when circulating RN is not very comfortable with IV placement and no other help (nurse anesthetist as in most European countries) is available.
Emma Davey M.D.:
Where I work, once the child is induced, I get my assistant (resident or nurse) to hold the mask while I place an IV. Once that's done, then I or my assistant secrues the airway. Thisworks well only if the child has a fairly easy airway to maintain with bag and mask, and if my assistant is fairly experienced at holding a mask on a child.
Bucky:
Not common practice in the USA. I was trained as were you. In a pinch, I'll go ahead and intubate then look for an IV when others have failed.
Hossam:
I think it is common trend where it is bit difficult to cannulate a young child either due to inaccessible veins or fearing of painful prick in case of lacking of EMLA cream. But I think we can do cannulation just after inhalation induction and before intubation to guard against unexpected events.
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