Editorial Views  |   September 2017
Out of the Darkness and into the Era of Direct Visualization and Deliberate Practice
Author Notes
  • From the Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas (A.C.A.); and Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (R.S.L.).
  • Corresponding article on page 423.
    Corresponding article on page 423.×
  • Accepted for publication June 12, 2017.
    Accepted for publication June 12, 2017.×
  • Address correspondence to Dr. Litman: litmanr@email.chop.edu
Article Information
Editorial Views / Pediatric Anesthesia / Radiological and Other Imaging / Technology / Equipment / Monitoring
Editorial Views   |   September 2017
Out of the Darkness and into the Era of Direct Visualization and Deliberate Practice
Anesthesiology 9 2017, Vol.127, 408-409. doi:10.1097/ALN.0000000000001777
Anesthesiology 9 2017, Vol.127, 408-409. doi:10.1097/ALN.0000000000001777
ARTERIAL cannulation is often required in anesthetized pediatric patients to facilitate hemodynamic monitoring or frequent blood sampling during major surgical procedures such as intracardiac and neurosurgical procedures, among others. In small children and neonates, successful arterial cannulation is technically challenging and may require multiple attempts at different locations. Most anesthesia providers will initially target cannulation of the radial artery and possibly the femoral artery as a second choice. In contrast, specialists in pediatric critical care and neonatology may also rely on the vessels of the foot, including the dorsalis pedis and posterior tibial arteries.
In this issue of Anesthesiology, Kim et al.1  report their findings of a comparison of arterial cannulation success between different anatomical locations in small children. In their two-part study, Kim et al. first conducted a suitability trial by using sonography to compare the diameters, cross-section areas, and depths of the radial, posterior tibial, and dorsalis pedis arteries in infants less than 2 yr of age. The second part consisted of a single-blinded randomized study that evaluated the first-attempt cannulation success rates at these three anatomical locations using ultrasound guidance and the incidence of posterior arterial wall puncture. The authors demonstrated that first-attempt success rates were similar for the posterior tibial and radial arteries, both of which were significantly greater than for the dorsalis pedis artery. Similarly, the rate of posterior arterial wall puncture was significantly greater when the dorsalis pedis artery was targeted compared with the posterior tibial and radial arteries. These success rates directly correlated with increased vessel sizes as seen by ultrasound visualization. In other words, the authors demonstrated that the cannulation failure rate was inversely proportional to vessel size as seen by ultrasound.
First Page Preview
First page PDF preview
First page PDF preview ×
View Large