title: Determination of optimum time for intravenous cannulation after induction with sevoflurane and nitrous oxide in children premedicated with midazolam.
abstract: BACKGROUND
  It has been shown that early placement of an intravenous line in children administered sevoflurane anesthesia increased the incidence of laryngospasm and movement. However, the optimal time for safe cannulation after the loss of the eyelash reflex during the administration of sevoflurane and nitrous oxide is not known.
  
  
  OBJECTIVE
  The aim of the study was to determine the optimum time for intravenous cannulation after the induction of anesthesia with sevoflurane and nitrous oxide in children premedicated with oral midazolam.
  
  
  METHODS
  We performed a prospective, observer-blinded, up-down sequential, allocation study, and children, aged 2-6 years, ASA physical status I, scheduled for an elective procedure undergoing inhalational induction were included in the study. Anesthesia was induced with sevoflurane and nitrous oxide after premedication with oral midazolam. For the first child, 4 min after the loss of the eyelash reflex, the intravenous cannulation was attempted by an experienced anesthesiologist. The time for intravenous cannulation was considered adequate if movement, coughing, or laryngospasm did not occur. The time for cannulation was increased by 15 s if the time was inadequate in the previous patient, and conversely, the time for cannulation was decreased by 15 s if the time was adequate in the previous patient. The probit test was used in the analysis of up-down sequences.
  
  
  RESULTS
  A total of 32 children were enrolled sequentially during the study period. The adequate time for effective intravenous cannulation after induction with sevoflurane and nitrous oxide in 50% and 95% of patients were 1.29 min (95% confidence interval, 0.96-1.54 min) and 1.86 min (95% confidence interval 1.58-4.35 min), respectively.
  
  
  CONCLUSIONS
  We recommend waiting 2 min for attempting intravenous placement following the loss of the eyelash reflex in children sedated with midazolam and receiving an inhalation induction with sevoflurane and nitrous oxide.
authors.affiliation: Department of Anaesthesiology and Reanimation, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey.
authors.forename: Alper
authors.initials: A
authors.lastname: Kilicaslan
authors.forename: Funda
authors.initials: F
authors.lastname: Gök
authors.forename: Atilla
authors.initials: A
authors.lastname: Erol
authors.forename: Selmin
authors.initials: S
authors.lastname: Okesli
authors.forename: Gamze
authors.initials: G
authors.lastname: Sarkilar
authors.forename: Seref
authors.initials: S
authors.lastname: Otelcioglu
mesh_terms: D000769:Anesthesia, Inhalation; D018685:Anesthetics, Inhalation; D002406:Catheterization, Peripheral / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D056805:Consciousness Monitors; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives; D008297:Male; D008738:Methyl Ethers; D008874:Midazolam; D009609:Nitrous Oxide; D011229:Preanesthetic Medication / Q000379:methods*; D011446:Prospective Studies; D012018:Reflex / Q000187:drug effects; D000077149:Sevoflurane
chemical_list: D018685:Anesthetics, Inhalation; D006993:Hypnotics and Sedatives; D008738:Methyl Ethers; D000077149:Sevoflurane; D009609:Nitrous Oxide; D008874:Midazolam
keywords: adverse events; child; induction of anesthesia; midazolam; nitrous oxide; sevoflurane