{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T16:14:17Z","timestamp":1765901657754,"version":"3.48.0"},"reference-count":20,"publisher":"Springer Science and Business Media LLC","issue":"S1","license":[{"start":{"date-parts":[[2025,2,27]],"date-time":"2025-02-27T00:00:00Z","timestamp":1740614400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/deed.de"},{"start":{"date-parts":[[2025,2,27]],"date-time":"2025-02-27T00:00:00Z","timestamp":1740614400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/deed.de"}],"funder":[{"name":"BINZ Foundation"},{"name":"Deutsche Interdisziplin\u00e4re Vereinigung f\u00fcr Intensiv- und Notfallmedizin"},{"name":"Klinikum der Universit\u00e4t M\u00fcnchen"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Med Klin Intensivmed Notfmed"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Intraosseous access (IO) is a\u00a0crucial, life-saving alternative vascular access in paediatric emergency medicine. In awake paediatric patients, the pain of drilling and flushing the marrow cavity are barriers to the use of the IO method or prompt the use of an intraosseous anaesthetic agent, which introduces the risk of dosing errors and drug toxicity. This study aims to identify the frequency of use of anaesthetic agents and analyse the time delay caused by their use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Prospective surveillance study analysing all patients, aged &gt;\u202f28\u00a0days to 18\u00a0years, who received one or more IO attempt(s) in and out of the hospital setting in Germany from 1\u00a0July 2017 to 30\u00a0June 2019 via the reporting mechanism of the German Paediatric Surveillance Unit (GPSU).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Our analysis identified 74\u00a0patients who received an IO attempt while awake. All patients were younger than 6\u00a0years old. Almost every third child (31.6%) was awake during IO use. In 18.9% of all awake patients, an intraosseous anaesthetic was used before the IO was drilled or the marrow cavity was flushed, introducing a\u00a0significant time delay of approximately 3\u202fmin (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u20090.001) compared to IO attempts without intraosseous anaesthesia.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Intraosseous anaesthesia prolongs the establishment of working vascular access in an emergency and introduces the risk of drug toxicity. To prevent adverse events, particular emphasis must be placed on placement without intraosseous anaesthesia, and alternative pain management (intranasal) must be considered if necessary. Training courses and guidelines should reflect the advised current practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00063-025-01253-0","type":"journal-article","created":{"date-parts":[[2025,2,28]],"date-time":"2025-02-28T09:33:48Z","timestamp":1740735228000},"page":"44-48","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Time delay and risk of toxicity of intraosseous anaesthesia use for awake intraosseous access in children","Zeitverz\u00f6gerung und Toxizit\u00e4tsrisiko beim Einsatz von intraoss\u00e4rer An\u00e4sthesie f\u00fcr den intraoss\u00e4ren Zugang beim wachen Kind"],"prefix":"10.1007","volume":"120","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4669-8611","authenticated-orcid":false,"given":"Daniel","family":"Pfeiffer","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Olivieri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victoria","family":"Lieft\u00fcchter","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Florian","family":"Hey","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Florian","family":"Hoffmann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,2,27]]},"reference":[{"issue":"1","key":"1253_CR1","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1016\/j.resuscitation.2011.08.017","volume":"83","author":"BA Leidel","year":"2012","unstructured":"Leidel\u00a0BA, Kirchhoff\u00a0C, Bogner\u00a0V, Braunstein\u00a0V, Biberthaler\u00a0P, Kanz\u00a0K\u2011G (2012) Comparison of intraosseous versus central venous vascular access in adults under resuscitation in the emergency department with inaccessible peripheral veins. 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The local ethics committee of the Rhineland\u2013Palatinate Medical Association and the state representative for data protection in Rhineland\u2013Palatinate have approved this protocol. A\u00a0waiver of written informed consent was granted by the Ethics Committee of the State Medical Association of Rhineland\u2013Palatinate (number 2020-15400_1) and the state representative for data protection in Rhineland\u2013Palatinate as participants were not subjected to any study-related procedures and data were collected in a\u00a0completely anonymous form. All analysed data involving human participants were collected in accordance with the ethical standards outlined in the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. In addition to the general ethical approval of the GPSU, the study was approved by the data protection office and the ethics committee of the medical faculty of the Ludwig-Maximilians-University, Munich No. 641-16 (19-12-2016).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The supplement containing this article is not sponsored by industry.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}