From Matt Careskey MD, Kapiolani Medical Center, Honolulu.
Aloha! I use ultrasound for nearly every arterial line I place, which are mostly the radial and occasionally the femoral artery. I have gotten into the practice of simply finding the ulnar artery ipsilateral to the target radial artery on ultrasound and assuring myself that it is patent with flow. Easy enough, and doesn't cost a nickel nor take more than 5 extra seconds to do.
With femoral lines, I think it is important -more important one could argue based on the safety profile or radial art lines- to verify that the femoral artery site you're cannulating isn't directly over top or underneath the femoral vein (and vice-versa for femoral vein central lines). This scenario is not an absolute contraindication to fem line placement. But you do have to understand the possible risk of creating a femoral A-V fistula if both vessels are punctured from a common needle path, and proceed accordingly.
Like with everything we do in peds anesthesia, we must do the same way that porcupines give each other hugs...carefully!
From Jerry Parness MD retired
This article in the October 31, 2024 PAAD on opioids, pain, and neurodevelopment after pediatric cardiac surgery raises my intellectual BP for a number of reasons:
The number of physiological, environmental, pharmacological, and developmental confounders in a retrospective cohort study such as this is simply astronomical and not knowable. No real conclusions can be drawn.
Assuming the hunches of the authors are possibly correct, what are the available and possible therapeutic interventions? Generalizations are made, but specific, testable approaches are not being made.
Dexmedetomidine has been around being used in the pediatric population - off label, mind you - for a good 15 years (Samantha Curtis et al. Use of Dexmedetomidine and Opioids in Hospitalized Preterm Infants JAMA Netw Open. 2023). Why have we not organized a reasonable clinical study on the effects of this remarkable drug on neurodevelopmental outcomes, as it allows for a reduction in delivered opioids (and likely benzodiazepines, as well) in this population?
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