Sevoflurane for central catheter placement in neonatal intensive care: A randomized trial

Fabrice Michel (1) , Renaud Vialet (1) , Sophie Hassid (1) , Claire Nicaise (1) , Aurélie Garbi (1) , Laurent Thomachot (1) , Jean-Noël Di Marco (1) , Pierre Lagier (1) , Claude Martin (1)

1 Réanimation Pédiatrique et Néonatale

Objective: To compare the efficacy and safety of sevoflurane deep sedation with glucose and non-nutritive sucking (GNNS) in reducing the duration of the procedure and in preventing pain-related effects during peripheral inserted central catheter (PICC) placement. Background: PICC placement in neonatal intensive care is a delicate and stressful procedure that requires pain prevention. GNNS have been recommended in this situation but remain often inefficient. Methods: We designed a randomized controlled study in a sixteen-bed paediatric and neonatal unit in a tertiary hospital. Fifty-nine neonates at >28 weeks of gestation with CPAP or invasive mechanical ventilation and requiring PICC placement were included. Patients were randomized to receive inhaled sevoflurane (IS) or glucose and non-nutritive sucking (GNNS). Procedural duration and conditions, hemodynamic and respiratory parameters, occurrence of movements and complications were compared (http://clinicaltrials.gov trial register no. NCT00420693). Results: The 2 groups had similar demographics. There were no between group differences in procedural duration (p=0.84) despite greater immobility in IS group (p=0.017). IS was also associated with fewer episodes of hypertension (p=0.003), tachycardia (p<0.001) and bradycardia (p=0.02). Occurrences of hypotension were not different between groups (p=0.06). The GNNS group showed more desaturation during the 4 hours after the procedure (p=0.03). Complications during intensive care stay did not differ between groups. Conclusion: Inhaled sevoflurane does not make easier catheters placement but prevent pain-related symptoms. Since sevoflurane is responsible for hypotension, it requires careful monitoring and treatment adaptation.

Mots clés: Medicine

Fabrice Michel, Renaud Vialet, Sophie Hassid, Claire Nicaise, Aurélie Garbi, et al.. Sevoflurane for central catheter placement in neonatal intensive care: A randomized trial. Pediatric Anesthesia, 2010, 20 (8), pp.712. ⟨10.1111/j.1460-9592.2010.03334.x⟩. ⟨hal-00552647⟩