Sevoflurane for central catheter placement in neonatal intensive care: a randomized trial.
OBJECTIVE
To compare the efficacy and safety of sevoflurane deep sedation with glucose and nonnutritive sucking (GNNS) in reducing the duration of the procedure and in preventing pain-related effects during peripherally inserted central catheter (PICC) placement.


BACKGROUND
PICC placement in neonatal intensive care is a delicate and stressful procedure that requires pain prevention. GNNS has been recommended in this situation but remain often inefficient.


METHODS
We designed a randomized controlled study in a sixteen-bed pediatric and neonatal unit in a tertiary hospital. Fifty-nine neonates at >28 weeks of gestation with continuous positive airway pressure or invasive mechanical ventilation and requiring PICC placement were included. Patients were randomized to receive inhaled sevoflurane (IS) or glucose and non-nutritive sucking (GNNS). Procedural duration and conditions, hemodynamic and respiratory parameters, occurrence of movements and complications were compared (http://clinicaltrials.gov trial register no. NCT00420693).


RESULTS
The two groups had similar demographics. There were no between-group differences in procedural duration (P = 0.84) despite greater immobility in IS group (P = 0.017). IS was also associated with fewer episodes of hypertension (P = 0.003), tachycardia (P < 0.001), and bradycardia (P = 0.02). Occurrences of hypotension were not different between the groups (P = 0.06). The GNNS group showed more desaturation during the 4 h after the procedure (P = 0.03). Complications during intensive care stay did not differ between groups.


CONCLUSIONS
Inhaled sevoflurane does not make easier catheters placement but prevent pain-related symptoms. Because sevoflurane is responsible for hypotension, it requires careful monitoring and treatment adaptation.
Michel
Fabrice
F
Faculté de Médecine de Marseille - Université de la Méditerranée, France. fabrice.michel@ap-hm.fr
Vialet
Renaud
R
Hassid
Sophie
S
Nicaise
Claire
C
Garbi
Aurélie
A
Thomachot
Laurent
L
DI Marco
Jean N
JN
Lagier
Pierre
P
Martin
Claude
C
D018685:Anesthetics, Inhalation / Q000009:adverse effects; D001786:Blood Glucose / Q000378:metabolism; D002405:Catheterization, Central Venous / Q000009:adverse effects; D005240:Feasibility Studies; D005260:Female; D005865:Gestational Age; D005947:Glucose; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D015931:Intensive Care, Neonatal; D008297:Male; D008738:Methyl Ethers / Q000009:adverse effects; D010146:Pain / Q000517:prevention & control; D010147:Pain Measurement / Q000187:drug effects; D011446:Prospective Studies; D015656:Respiratory Mechanics / Q000502:physiology; D000077149:Sevoflurane; D013391:Sucking Behavior; D016896:Treatment Outcome
D018685:Anesthetics, Inhalation; D001786:Blood Glucose; D008738:Methyl Ethers; D000077149:Sevoflurane; D005947:Glucose