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03-10-2011 | General practice | Article

50% nitrous oxide assists IV access in some children and adolescents


Free abstract

MedWire News: In obese or growth-retarded children and adolescents, administration of 50% nitrous oxide during intravenous (IV) line procedures results in improved access and shorter treatment times, study findings indicate.

Children and adolescents with obesity or endocrine disorders often need to undergo repeat blood testing or other procedures that require IV lines. The resulting venous scarring can lead to difficulty in setting up these lines and increased patient pain. Topical anesthetics and lidocaine injections can help alleviate some pain, but not in extreme cases.

The sedative effects of midazolam and nitrous oxide have previously been compared in pediatric studies. Kerstin Ekbom (Karolinska Institute, Stockholm, Sweden) and colleagues tested the efficacy of these agents in children and adolescents who have difficulties with or are anxious about IV line access and installation.

Sixty obese and 30 growth-retarded children aged 5 to 18 years were randomly assigned to receive 0.3 mg/kg oral midazolam, inhaled 10% nitrous oxide, or inhaled 50% nitrous oxide. The primary treatment endpoints were number of attempts at IV line setup and total procedure times (IV access time plus recovery time, including regaining alertness). Results are reported in the Archives of Pediatric and Adolescent Medicine.

Total procedure times were longer in those given midazolam than in those given either dose of nitrous oxide, particularly in the obese children. While there were no significant differences between groups in the number of total IV access attempts, 67% of patients treated with 50% nitrous oxide had successful IV line procedures, versus 40% of patients in the 10% nitrous oxide group, and 37% of patients in the midazolam group.

Patients given 50% nitrous oxide had less reported pain than patients given midazolam or 10% nitrous oxide. Nurse and parent evaluation scores were also more favorable for 50% nitrous oxide. Overall, only two patients had adverse events: one had nausea after 50% nitrous oxide and one had dizziness after midazolam administration.

The investigators did not do any long-term follow-up of the patients, particularly in regards to any potential amnesiac effects in the midazolam group.

However, they conclude that based on the data, "treatment with 50% nitrous oxide is preferable to treatment with midazolam for facilitating the IV line procedure in anxious children and adolescents. Only under rare circumstances should obese children or adolescents be treated with midazolam because of the long procedure time."

By Stephanie Leveene

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