Christian Breschan

Impact The essential role of ultrasound in the various phases of insertion and evaluation of CICC and FICC is emphasized. The importance of standardized protocols for assessment, insertion and evaluation is highlighted. Implementation of this recommendation improves patient safety and reduces practice variation.

Obesity is one of the most common clinical conditions in the pediatric population with an increasing prevalence ranging from 20 to 30% worldwide. It is well known that during ambulatory anesthesia, obese children are more prone to develop perioperative respiratory adverse events (PRAEs) associated with obesity. To avoid or at least minimize these adverse effects, a thorough preoperative assessment should be undertaken as well as consideration of specific anesthetic approaches such as preoxygenation before induction of anesthesia and optimizing drug dosing. The use of short-acting opioid and nonopioid analgesics and the frequent implementation of regional anesthesia should also be included. Noninvasive airway management, protective mechanical ventilation, and complete reversion of neuromuscular blockade and awake extubation also proved to be beneficial in preventing PRAEs. During the postoperative period, continuous monitoring of oxygenation and ventilation is mandatory in obese children. In the current review, we sought to provide recommendations that might help to reduce the severity of perioperative respiratory adverse events in obese children, which could be of particular importance for reducing the rate of unplanned hospitalizations and ultimately improving the overall postoperative recovery.

Background: The aim of this retrospective analysis was to evaluate the clinical feasibility of the supraclavicular ultrasound‐guided cannulation of the brachiocephalic vein in infants weighing less than 1500 g.Methods: The ultrasound probe was placed in the supraclavicular region so as to obtain the optimum sonographic long‐axis view of the brachiocephalic vein. By using an in‐plane approach the brachiocephalic vein was cannulated by using a 24‐gauge intravenous cannula under real‐time ultrasound guidance into the vein followed by the insertion of a 2‐French single lumen catheter using the Seldinger technique.Results: Forty‐six brachiocephalic vein cannulations in infants weighing between 0.55 and 1.5 kg (Median: 1.2; 95%‐CI: 0.9‐1.2) were included. Ultimate success rate was 89.1% (41 out of 46). One cannulation attempt was required in 30 (65.2%) patients, 2 in 6 (13%) and 3 in 5 (10.8%), respectively. Smaller weight babies did not require significantly more cannulation attempts. The probability of successful cannulation on the first attempt increased significantly from 40% (2010) to more than 80% (2019) over the time course of this series. Median catheter dwell time was 15 days (95%‐CI: 9‐20) with one catheter being removed prematurely after 8 days due to obstruction.Conclusion: Supracalvicular in‐plane real‐time ultrasound‐guided cannulation of the brachiocephalic vein seems to be a convenient and feasible option to provide large‐bore central venous access for very small and sick babies.

Summary: Background: The supraclavicular ultrasound (US)‐guided cannulation of the brachiocephalic vein (BCV) is one option of central venous line placement in infants.Aim: The aim of this prospective study was to evaluate whether there was an association between the optimum ultrasonographic view as obtained of the entire longitudinal extension of the rightBCVand the ease of supraclavicular cannulation when using a strict in‐plane technique via a linearUSprobe in small infants.Methods: TheUSprobe was placed in the right supraclavicular region. If the optimum obtainable sonographic view presented the entire longitudinal extension of the rightBCVdemonstrating clearly its path caudally alongside the pleura, it was graded as I. If, however, only a circular view, i.e., the initial part of the rightBCVwas obtainable viaUS, it was graded asII. The rightBCVwas cannulated by advancing a 22‐gauge i.v. cannula from lateral to medial strictly under the long axis of theUSprobe under directUSvision into the vein.Results: Seventy‐nine infants weighing between 0.8 and 4.5 kg (Median: 3.4 ± 0.09) were included. In 50 (63.3%) patients, the sonographic view was graded as I and in 29 (36.7%) asII. The proportion of patients successfully cannulated on the first attempt was significantly smaller in patients graded asII, i.e., circular, sonographic view of the rightBCVthan in patients graded as I, i.e., sonographic view of the entire longitudinal extension of the rightBCV(41% vs 90%; chi‐square analysis:P < 0.01).Conclusion: The sonographic view obtainable of the entire longitudinal extension of the rightBCVresulted in significantly fewer required cannulation attempts.