Local Nitroglycerin For Radial Artery Cannulation In Neonates- A Randomised Controlled Trial

Radial artery cannulation in neonates is technically challenging due to small vessel diameter and a high incidence of arterial spasm, leading to multiple attempts and complications. Nitroglycerin is a potent vasodilator that has shown to  increase radial artery diameter and reduce arterial spasm in adults and older children. Limited data exist regarding its use in neonates, particularly via subcutaneous route. This prospective, randomized controlled trial aims to evaluate the efficacy and safety of subcutaneous nitroglycerin in improving the first-attempt success rate of ultrasound-guided radial artery cannulation in neonates.

Ninety-four neonates undergoing surgery under general anaesthesia will be randomized to receive either subcutaneous nitroglycerin (5mcg/kg) or normal saline over the radial artery under ultrasound guidance prior to cannulation. Cannulation will be performed using dynamic needle tip positioning technique.

Primary outcome is first-attempt success rate. Secondary outcome include total number of attempts, procedure time, changes in radial artery diameter and depth, and incidence of local or systemic complications such as vasospasm, hematoma and hypotension

This study aims to establish a safe and effective strategy to improve arterial cannulation success in neonates and reduce procedure related complications.