We do a lot of volatile inductions in the dental office in patients who are too young or too anxious for iv induction. Normally this is smooth if you make sure the arms and hands are fixated by a helper when you put in the iv as this may cause a muscle contraction reaction
However as @drrobbieerskine.bsky.social et al were saying it pays to take your time. I'd teach trainees that if the child reacted to IV cannulation it was a sign they weren't deep enough to tolerate even LMA insertion, and to wait and go deeper. (Or you could now also give something IV to help)
Agreed I would add that a touch of intradermal LA prior to cannulation a. Helps identify depth of anaesthesia and b.then allows withdrawal free cannulation should depth be inadequate ..A win win 😊
Yes to both counts
I appreciate the gesture though 😊
Under circumstances you can justify an entire anaesthetic without IV access. Eg paed RadRx where almost daily anaesthetics for up to a month means balancing risks of long term access vs IV-less airway management which is safe when done intentionally & with experience (eg ensure deep anaesthesia)
Which supports the point made earlier that safety is better thought of as relative not absolute.
In any given circumstance, what is deemed 'safe' or 'unsafe' is going to be determined by what risks are 'acceptable', and what risks are 'acceptable' will in turn depend, among other things, on the context, what's at stake, and who is doing the 'accepting' and the 'deeming'.
And what the tradeoffs are, eg multiple attempts at lines ruining what veins are left in someone that may need multiple episodes of care in the near future or CLABSIs
As my good friend @dr-amit-pawa.bsky.social would say "If you think you're the smartest person in the room, you're in the wrong room" 😉
That's how I have been taught as well