Factors associated with intraoperative intravenous catheter extravasation in children

Summary This retrospective study aimed to determine the incidence of and factors associated with peripheral intravenous extravasation in paediatric patients in the intraoperative setting. We conducted a retrospective study of 56,777 patients who underwent general anaesthesia and had peripheral intravenous catheter placement at Cincinnati Children’s Hospital between 1 January 2015 and 1 January 2017. Data collected included age, American Society of Anesthesiologists Physical Status Classification, catheter site, number of cannulation attempts, ultrasound use for cannulation, surgery duration, and surgery class. Primary outcome was peripheral intravenous extravasation using an extravasation assessment tool. Some 64,814 peripheral venous catheters were placed in patients undergoing general anaesthesia. Significant extravasation was documented in 40 catheters with an estimated incidence of 1 in 1620 venous catheters (0.06%). Of those 40 catheters, 47.5% ( n = 19) were placed using ultrasound and 37.5% ( n = 15) required more than one cannulation attempt. In multivariable analysis, peripheral intravenous catheter extravasation was associated with American Society of Anesthesiologists Physical Status Classification (3, 4, 5) versus (1, 2) (odds ratio 2.42 (95% CI 1.08 to 5.41)), inpatient versus outpatient surgeries (odds ratio 2.99 (95% CI 1.31 to 6.81)), and intravenous catheters placed with ultrasound guidance (odds ratio 8.01 (95% CI 4.12 to 15.57)). Our study identified factors associated with intraoperative peripheral intravenous extravasation, and will help develop mitigation strategies to minimise harm to patients. </jats:p

sj-pdf-1-aic-10.1177_0310057X211062614 - Supplemental material for Factors associated with intraoperative intravenous catheter extravasation in children

Supplemental material, sj-pdf-1-aic-10.1177_0310057X211062614 for Factors associated with intraoperative intravenous catheter extravasation in children by Mecoli Marc D Conceptualization Data curation Formal analysis Investigation Methodology Writing original draft Writing review editing Ding Lili Formal analysis Investigation Writing review editing Yang Gang Formal analysis Investigation Software Writing review editing McSoley Joseph W Investigation Visualization Writing review editing Doellman Darcy A Conceptualization Investigation Writing review editing Rineair Sylvia A Conceptualization Investigation Writing review editingSubramanyam Rajeev Conceptualization Formal analysis Investigation Methodology Supervision Writing review editing in Anaesthesia and Intensive Care</p

CYP2D6 pharmacogenetic and oxycodone pharmacokinetic association study in pediatric surgical patients

Aim: Oxycodone is partly metabolized to the active metabolite oxymorphone by hepatic CYP2D6 in the liver. Significant genetic variability in CYP2D6 activity affects oxymorphone formation. This study aimed to associate CYP2D6 genotype and oxycodone's metabolism. Methods: 30 children were administered oral oxycodone postoperatively. Plasma levels of oxycodone and oxymorphone, and CYP2D6 genotype were analyzed. CYP2D6 genotype and oxycodone metabolism phenotype were determined based on CYP2D6 total activity score (TAS) and metabolism phenotype: poor metabolizer (PM), intermediate metabolizer (IM), extensive metabolizer (EM) or ultrarapid metabolizer (UM). Results: Compared with PM/IM subjects, significantly greater oxymorphone exposure was seen in EM subjects (p = 0.02 for Cmax, p = 0.016 for AUC0–6 and p = 0.026 for AUC0–24). Similarly, higher TAS value was found to be associated with greater oxymorphone exposure. Higher conversion of oxycodone to oxymorphone was observed in EM subjects compared with PM/IM subjects (p = 0.0007 for Cmax, p = 0.001 for AUC0–6 and p = 0.004 for AUC0–24). Conclusion: CYP2D6 phenotypes explain metabolism of oxycodone in children, and oxymorphone exposure is higher in CYP2D6 EM phenotype. Further studies are needed to predict the occurrence of adverse event and tailor oxycodone dose for a specific CYP2D6 phenotype. </jats:p

sj-jpg-2-aic-10.1177_0310057X211062614 - Supplemental material for Factors associated with intraoperative intravenous catheter extravasation in children

Supplemental material, sj-jpg-2-aic-10.1177_0310057X211062614 for Factors associated with intraoperative intravenous catheter extravasation in children by Mecoli Marc D Conceptualization Data curation Formal analysis Investigation Methodology Writing original draft Writing review editing Ding Lili Formal analysis Investigation Writing review editing Yang Gang Formal analysis Investigation Software Writing review editing McSoley Joseph W Investigation Visualization Writing review editing Doellman Darcy A Conceptualization Investigation Writing review editing Rineair Sylvia A Conceptualization Investigation Writing review editing Subramanyam Rajeev Conceptualization Formal analysis Investigation Methodology Supervision Writing review editing in Anaesthesia and Intensive Care</p