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Vaskulärer Zugang in der Kindernotfallanästhesie

Vascular access in emergency paediatric anaesthesia

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Zusammenfassung

Zum Thema des schwierigen intervenösen Zugangs bei pädiatrischen Notfallsituationen existieren erstaunlich wenige Angaben in der Literatur. „Wie machen es die Anderen?“ war die Motivationsgrundlage für eine Umfrage bei in Kinderanästhesie erfahrenen Anästhesisten.

Insgesamt 89 Fragebögen wurden an die Leiter der Weiterbildungsstätten für Anästhesie in der Schweiz und an alle Mitglieder der Schweizerischen Gesellschaft für Kinderanästhesie verschickt. Anhand von 2 Fallbeispielen (Fall A: nicht nüchternes Kleinkind mit einer Radiusfraktur, Fall B: Säugling mit hohem Ileus) wurde das weitere Vorgehen nach 2–3 erfolglosen peripheren Punktionsversuchen erfragt. Die Beantwortung ergab, dass die meisten der Befragten in beiden Situationen zunächst weitere periphere Venenpunktionen vornehmen werden. Falls diese Versuche erfolglos bleiben, wird beim Kleinkind mit der Radiusfraktur eine intramuskuläre oder inhalative Anästhesieeinleitung befürwortet. Bei dem Säugling mit Ileus wird versucht, für die Anästhesieeinleitung einen intraossären oder zentralvenösen Zugang (V. femoralis) zu legen. Aufgrund der Resultate der Umfrage und einer Literaturrecherche wird eine Prioritätenliste zu den wichtigsten vaskulären Zugängen und alternativen Anästhesieeinleitungsmethoden in der pädiatrischen Notfallsituation vorgeschlagen.

Abstract

There is very little literature to guide the young practitioner in caring for a child that needs emergency surgery and has difficult venous access.

Questionnaires were sent to 89 members of the Swiss Paediatric Anaesthesia Society and to the heads of Anaesthesia Departments of Swiss teaching hospitals. Two typical case records were presented, both of which were characterised by the fact that 2–3 peripheral venous cannulation attempts were unsuccessful. Case A: a young child with a fracture of the radius and case B an infant with upper gastrointestinal ileus. The anaesthetists were then questioned regarding their preferences for optimal treatment. The majority would proceed with further attempts and, if these still failed, intramuscular or inhalational induction of anaesthesia was suggested as a reasonable choice for case A. However, for case B, a femoral venous or intraosseous access to the venous system was judged to be the safest method. On the basis of our inquiry and a literature search, a priority list was developed to suggest the best possible techniques for vascular access and alternative anaesthesia induction techniques for emergency paediatric procedures.

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Authors and Affiliations

  1. Universitäts-Kinderspital beider Basel (UKBB), Basel, Schweiz

    E.-M. Jordi Ritz, T. O. Erb & F. J. Frei

  2. Abteilung Anästhesie, Universitäts-Kinderspital beider Basel (UKBB), Römergasse 8, 4005, Basel, Schweiz

    E.-M. Jordi Ritz

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  1. E.-M. Jordi Ritz
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  3. F. J. Frei
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Correspondence to E.-M. Jordi Ritz.

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Jordi Ritz, EM., Erb, T.O. & Frei, F.J. Vaskulärer Zugang in der Kindernotfallanästhesie. Anaesthesist 54, 8–16 (2005). https://doi.org/10.1007/s00101-004-0794-x

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