• Severine Gras, Fabian Roy-Gash, Béatrice Bruneau, Nadège Salvi, Anne-Emmanuelle Colas, Alia Skhiri, Gilles Orliaguet, Souhayl Dahmani, and Jean-Michel Devys.
• From the Departement d'Anesthesie Reanimation, Fondation Ophtalmologique Adolphe de Rothschild (SG, FRG, AEC, JMD), Departement d'Anesthesie Reanimation, APHP-Hopital Necker (NS, GO) and Departement d'Anesthesie Reanimation, APHP-Hopital Robert Debre, Paris, France (BB, AS, SD).
• Eur J Anaesthesiol. 2021 Aug 1; 38 (8): 888894888-894.

BackgroundDuring inhalational induction of anaesthesia for children, severe respiratory events can occur but can be rapidly treated once intravenous access is in place. Reducing the time to successful cannulation during inhalational induction for children with poor vein visibility would improve safety.ObjectiveTo study the effectiveness of a near-infrared (NIR) vascular imaging device (Veinviewer) to facilitate intravenous cannulation.DesignA prospective, multicentre, randomised, open clinical trial.SettingThe operating rooms of three paediatric hospitals in Paris, France, from 1 October 2012 to 31 March 2016.PatientsChildren up to the age of 7 years, with poor vein visibility requiring general anaesthesia.InterventionInhalational anaesthesia was initiated and intravenous cannulation was performed with the standard approach or with the Veinviewer Vision.Main Outcome MeasuresThe primary outcome was the time to successful intravenous cannulation. A secondary outcome was the proportion of successful first attempts.ResultsThe mean time to successful intravenous cannulation was 200 (95% CI, 143 to 295) seconds in the Veinviewer and 252 (95% CI, 194 to 328) seconds for the control group: hazard ratio 1.28 (1.02 to 1.60) (P = 0.03). The adjusted hazard ratio for known predictive factors was 1.25 (0.99 to 1.56) (P = 0.06). Success at the first attempt was 64.6% (102/158) in the 'Veinviewer' group vs. 55.6% (85/153) in the 'control' group (P = 0.10).ConclusionThe Veinviewer has limited value in reducing the time to successful intravenous cannulation during inhalational anaesthesia for young children with poor vein visibility. However, there is a strong trend to reducing the delay in some cases and, given its absence of side effects, it could be part of a rescue option for a difficult venous-access strategy.Clinical Trial RegistrationNCT01685866 (http://www.clinicaltrials.gov).Copyright © 2021 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.

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