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To compare ultrasound (US)-guided radial artery cannulation with the traditional palpation technique.Prospective randomized study.Operating room in a tertiary care pediatric center.One hundred fifty-two children under 18 yrs of age requiring radial artery cannulation.Patients were randomized to either 1) palpation or 2) US guidance technique for radial artery cannulation.The primary end point of the study was the time taken for attempted cannulation by the first operator at the first site. Secondary end points included the number of attempts at arterial cannulation, the number of cannulae used, and the need for additional assistance from another anesthesiologist. Eighty and 72 children were randomized to the palpation and the US-guided groups, respectively. There were no statistically significant differences in age, gender, weight, and systolic blood pressure between the two study groups. The designated first operator (20 pediatric subspecialty trainees and eight consultant anesthesiologists) had previous experience in US-guided arterial cannulation in <10 cases, with 94% having experience in <5 cases. Although the radial artery was eventually cannulated in all patients, the designated operator was successful at the first site of cannulation in only 66% and 69% in the palpation and US groups, respectively. There were no statistically significant differences between the groups in time to successful cannulation, total number of attempts, number of successful cannulations during the first attempt, or in the number of cannulae used for catheterization.US guidance did not facilitate faster cannulation of the radial artery in children in our study.