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Intraosseous Infusions: A Review for the Anesthesiologist with a Focus on Pediatric Use

Tobias, Joseph D. MD*†; Ross, Allison Kinder MD‡§

doi: 10.1213/ANE.0b013e3181c03c7f
Pediatric Anesthesiology: Review Article

Intraosseous (IO) access is used most frequently for emergency care of critically ill infants and children when IV access cannot be rapidly achieved. Despite its efficacy in such situations, applications outside of the emergency room or resuscitation scenario have been limited. Furthermore, although the technique is emphasized in the teaching of those caring for critically ill infants and children in the emergency room or critical care setting, there is limited emphasis on its potential use in the perioperative setting. When peripheral venous access cannot be achieved in the operating room, alternative means of securing vascular access such as central line placement or surgical cutdown are generally successful; however, these techniques may be time consuming. Anyone providing anesthesia care for infants and children may want to become facile with the use of IO infusions for selected indications. We present the history of IO infusions, review the anatomy of the bone marrow space, discuss the potential role of IO infusions in the perioperative period, and analyze its adverse effect profile.

Published ahead of print November 6, 2009

From the Departments of *Anesthesiology, and †Pediatrics, University of Missouri, Columbia, Missouri; and Departments of ‡Anesthesiology, and §Pediatrics, Duke University, Durham, North Carolina.

Accepted for publication August 27, 2009.

Published ahead of print November 6, 2009

Address correspondence and reprint requests to Joseph D. Tobias, MD, Department of Anesthesiology, University of Missouri, 3W-27G HSC, One Hospital Dr., Columbia, MO 65212. Address e-mail to

© 2010 International Anesthesia Research Society
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