NEW YORK (Reuters Health) – For children and adolescents with conditions that require frequent placement of intravenous lines, administration of 50% nitrous oxide makes the process of IV access more efficient and more acceptable for the patient, a Swedish team reports in the Archives of Pediatrics and Adolescent Medicine online May 2.

Repeated IV access in children with endocrine disorders and other chronic conditions often leads to hardened vessels, increased pain sensitivity, patient distress and problems placing IV lines, the authors point out. Local anesthetics are not always effective enough, they note.

Kerstin Ekbom, RN, and colleagues at the Karolinska Institute in Stockholm, tested the effectiveness of oral midazolam versus inhaled nitrous oxide in establishing two IV lines in 90 patients aged 5 to 18 years with reported anxiety or difficulties with the procedure.

Sixty participants were obese and 30 had growth retardation. A third of each group was assigned to receive midazolam orally 0.3 mg/kg with 15 mL of syrup and use an oxygen mask; one third was given 50% nitrous oxide via inhalation with 15 mL of syrup; and the remaining third received 10% nitrous oxide with 15 mL of syrup. All patients received applications of lidocaine-prilocaine at access sites.

The total procedure time was significantly longer with midazolam, especially in obese children, than with either dose of nitrous oxide, according to the report. There were no significant differences between the treatment arms in the number of access attempts needed.

“Furthermore, the percentage of successful IV line procedures was higher in patients treated with 50% nitrous oxide than in patients treated with 10% nitrous oxide or and midazolam (67%, 40%, and 37%, respectively; p=0.04),” the team found.

Patients’ evaluations of the procedure were more positive for 50% nitrous oxide treatment than for either of the other treatments, the authors note.

Dizziness occurred in one patient given midazolam and one given 50% nitrous oxide. No cardio-respiratory adverse events occurred.

Given these results, “Treatment with 50% nitrous oxide is therefore preferable to treatment with midazolam for facilitating the IV line procedure in anxious children and adolescents,” Ekbom and colleagues conclude.

“Only under rare circumstances should obese children or adolescents be treated with midazolam because of the long procedure time,” they add.

Reference:

Efficient Intravenous Access Without Distress


Arch Pediatr Adolesc Med 2011.