Topical refrigerant spray for pediatric venipuncture for outpatient surgery

Anxiety in the pediatric patient population is a problem for outpatient anesthesia because of poor patient compliance during the initiation of the anesthetic technique. A variety of techniques have been used in the outpatient surgery and emergency department settings to improve cooperation in the pediatric age group or those with developmental and cognitive delay. These adjunctive techniques include the growing popularity of the use of eutectic mixtures of local anesthetic cream, nitrous oxide, oral premedication, and intramuscular injections. A highly effective technique to use during intravenous catheter insertion is the use of a refrigerant spray, ethyl chloride, to cause a transient local hypoesthesia of the skin at the venipuncture site. This technique is not associated with any significant contraindications or adverse reactions, and it should be considered for both pediatric and adult patients in the oral and maxillofacial surgery practice.