title: Anesthesia through an intraosseous line using an 18-gauge intravenous needle for emergency pediatric surgery.
abstract: OBJECTIVE
  To describe the success and complication rate of intraosseous (IO) access for delivery of anesthesia with the use of an 18-gauge (G) intravenous (IV) needle.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Children's Welfare Teaching Hospital, Baghdad, Iraq.
  
  
  METHODS
  300 critically ill infants and toddlers, age 3 weeks to 16 months, requiring emergency surgery for intra-abdominal or pelvic conditions, in whom peripheral or central access was not obtainable. Patients presented for surgery between 2007 and 2010.
  
  
  METHODS
  In 26 patients, the IO catheter was established when peripheral access was not obtained at the outset of surgery; in 4 patients standard peripheral vascular access failed during the surgical procedure and IO access was obtained. An 18-G IV needle was placed into the proximal tibia and attached to an extension set with a 3-way stopcock to deliver anesthesia.
  
  
  RESULTS
  For 26 critically ill children and 4 other children, IV access failed during delivery of anesthesia; vascular access was successfully obtained within minutes in all 30 infants (100%) using the intraosseous route. Ninety percent (27/30) of patients awoke immediately postoperatively in good condition; 10% (3/30) went to the pediatric intensive care unit (PICU) for further care due to their critical preoperative condition. Complications associated with use of the IO route were considered minor (3/30 pts [10%]) and included extravasation of fluid in two cases and cellulitis in one.
  
  
  CONCLUSIONS
  The IO route provided for rapid delivery of anesthesia, induction, and maintenance in this series of critically ill infants undergoing emergency surgery when other vascular access routes failed. Few complications were noted. Intraosseous access was achieved through a simple technique using an 18-gauge IV needle.
authors.affiliation: Department of Pediatric and Neonatal Anesthesia, Children's Welfare Teaching Hospital, Medical City, Baghdad, Iraq. Electronic address: drriyadhkh@yahoo.com.
authors.forename: Riyadh Khudeir
authors.initials: RK
authors.lastname: Hamed
authors.forename: Sharon
authors.initials: S
authors.lastname: Hartmans
authors.forename: Marianne
authors.initials: M
authors.lastname: Gausche-Hill
mesh_terms: D000005:Abdomen / Q000601:surgery; D000771:Anesthesia, Intravenous / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D004630:Emergencies; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017148:Infusions, Intraosseous / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D008297:Male; D009339:Needles; D010388:Pelvis / Q000601:surgery; D011446:Prospective Studies; D013977:Tibia
chemical_list: D018686:Anesthetics, Intravenous
keywords: Anesthesia: intraosseous route; Catheterization; Emergency surgery; Pediatrics