[Subclavian vein cannulation success or failure in neonates and children]

Central vein cannulation [CVC] allows administration of large volumes of fluids in short times and at high osmolaritiy for rehydration, volume replacement, chemotherapy and parenteral nutrition. Percutaneous central venous line insertion has replaced peripheral venous cut-down as the primary mode of short term venous access in children. 3264 subclavian vein cannulations in neonates and children were analyzed regarding successful attempt for catheterization and early complication rates after the procedure retrospectively. We had 1340 newborn patients [first 28 days of life] in our study population. In this group, only 55cannulations were failed, 1 patient were complicated with pneumothorax, in 21 cases guide wires became malfunction and only in 981 cases attempts to cannulation were successful in first attempt. In the remaining 1924 patients, 1 month to 8 years old, only 14 attempts to cannulation of subclavian vein was failed and in 1655 cases cannulation performed successfully at first attempt. CVC success rate was significantly higher in children older than 1 month compare to less than 1 month age [P=0.03]. Cannulation of central vein in neonates and children in a skilled hand would be performed with great success rate and low complications but in neonates less than 1 month age it has higher failure rate

Reduction in labor pain by intrathecal midazolam as an adjunct to sufentanil / 대한마취과학회지

BACKGROUND: Anesthesia today has strived to decrease labor pain in a tolerable and controllable fashion. Intrathecal midazolam has been introduced as an adjunct to analgesics. The study was planned to assess the efficacy, safety and duration of analgesia produced by intrathecal midazolam adjunct to sufentanil in decreasing labor pain. METHODS: In a randomized clinical trial 80 parturient included in the study. The two groups were matched for age, cervical dilation, gravid, gestational age, and other demographic characteristics. Combination of sufentanil and midazolam administered intrathecally to experimental group and compared to sufentanil group. Time to reach maximum block, and pain score was measured and recorded. RESULTS: Groups were matched for age and weight and other demographic characteristic. No significant adverse effect was seen in both groups including decrease in Apgar score. Duration of analgesia was 92.0 +/- 12.7 in sufentanil group and 185.2 +/- 15.2 minutes in midazolam and sufentanil group which was significantly different (P = 0.002). Numeric rating scale score was significantly lower in midazolam group compare to sufentanil group at 120 min (P = 0.01), 150 min (P = 0.0014), and 180 min (P = 0.001). CONCLUSIONS: Intrathecal midazolam as an adjunct to opioid could significantly enhance analgesia in labor pain with no significant adverse effect. Intrathecal injection of midazolam is an appropriate alternative to parenteral or epidural analgesia in small hospital settings.