Efficacy of Ultrasound-guided Internal Jugular Vein Versus Supraclavicular Subclavian Vein Cannulation in Neonates and Infants Less Than 5 kg Undergoing Major Surgeries: a Prospective, Randomized Controlled Trial.

The aim of this study is to compare the effectiveness and safety of ultrasound- guided IJV and supraclavicular SCV cannulation in infants weighing less than 5 kg.

It is hypothesized that ultrasound guided supraclavicular SCV cannulation has a higher success rate compared to IJV cannulation.

Infants will be recruited into the trial during pre-operative assessment. Recruited infants will be randomly assigned to one of two groups in a 1:1 ratio; (group S) to receive ultrasound guided SCV cannulation and (group I) to receive ultrasound guided IJV cannulation. Randomization will be achieved using a computer-generated sequence. Concealment will be achieved using opaque envelopes.

All infants will be anesthetized in accordance with the local policy of pediatric anesthesia unit in Abu El-Reesh pediatric hospital-Cairo university after ethics committee approval.

After preoperative examination and upon arrival to the operating room heart rate, noninvasive blood pressure NBP and oxygen saturation SPO2 will be monitored using standard monitor (drȁger infinity vista XL) before inhalational induction of anesthesia using titration of sevoflurane in oxygen air mixture 60% (starting from 3% up to 8%) until the infant is put to sleep. After securing an intravenous line anesthesia will be completed with 1-2µg/kg of fentanyl and atracurium 0.5 mg/kg.