Sedation for Pediatric Patients Undergoing CT and MRI

Hubbard, Anne M.; Markowitz, Richard I.; Kimmel, Barbara; Kroger, Margaret; Bartko, Mary Beth

doi:10.1097/00004728-199201000-00002

Cited by 120 publications

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“…Sedation is ordered in half of all pediatric cases and, in most children under 7 years old, to prevent movement. Sedation adds risk of transient hypoxia, prolonged profound sedation, and respiratory depression (Hubbard, Markowitz, Kimmel, Kroger, & Bartko, 1992).Slifer, Cataldo, Cataldo, and Burke (1989) reported using contingent videotape viewing plus token reinforcement with a 94% success rate for patients meeting a movement criterion of 2 mm per second or less during a 20-min simulated scan. These individuals subsequently cooperated with actual MRI scans without sedation, and the resulting images were judged by medical staff to be of good quality.…”

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confidence: 99%

Behavior Analysis of Motion Control for Pediatric Neuroimaging

Slifer

Cataldo

et al. 1993

J of App Behav Analysis

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Magnetic resonance imaging is a promising technological advance used for research and diagnosis of disease. The procedure has no risks, except when uncooperative patients require sedation. Four normal children participated in simulated scans to study the effects of (a) antecedent changes in the imaging environment and (b) operant conditioning of movement inhibition. Changing the environment can decrease movement, but operant contingencies were necessary to decrease movement to a level that, in most cases, would allow the procedure to occur without sedation.DESCRIPTORS: behavioral pediatrics, feedback, magnetic resonance imaging, movement control, patient compliance Magnetic resonance imaging (MRI) is a noninvasive tool for viewing internal anatomy. Patients lie in an endosed, noisy machine for 20 min or more. Movement decreases image resolution, but the exact movement threshold for a failed scan is unknown. The usability of the images can be evaluated only by viewing them after staff and scanner time has been invested. Sedation is ordered in half of all pediatric cases and, in most children under 7 years old, to prevent movement. Sedation adds risk of transient hypoxia, prolonged profound sedation, and respiratory depression (Hubbard, Markowitz, Kimmel, Kroger, & Bartko, 1992).Slifer, Cataldo, Cataldo, and Burke (1989) reported using contingent videotape viewing plus token reinforcement with a 94% success rate for patients meeting a movement criterion of 2 mm per second or less during a 20-min simulated scan. These individuals subsequently cooperated with actual MRI scans without sedation, and the resulting images were judged by medical staff to be of good quality. These subjects were not acutely ill, in pain, or in urgent need of MRI, but induded a range of ages (5 to 46 years), developmental disabilities, and psychiatric diagnoses. However, functional control was not demonstrated. The present study demonstrates functional control over normal children's movement during simulated MRI scans and conducts a partial component analysis of the Slifer et al. (1989) procedure.METHOD: Subjects were normal children who, with parental consent, volunteered for simulated scans. There were 2 boys and 2 girls (5 and 6 years old) from middle-income families with no developmental or medical disorders. The simulated MRI (using an inactive scanner) lasted 20 min (the length of a brain scan). A helmet-like "head coil" covered the child's face, with vision possible through a mirror (standard on MRI scanners). Head supports and safety straps used during MRI were used during simulation. The examination table moved mechanically, and taped scanner noises were played at high volume.Movement was measured with precision potentiometers (Technology Instruments Corp.). Potentiometers have often been used to measure movement in biomedical research (e.g., Melvill-Jones, Guitton, & Berthoz, 1988). The apparatus was connected to the child's forehead by nylon string and an adhesive patch. Head movement activated the potentiometers, which translate...

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confidence: 99%

Behavior Analysis of Motion Control for Pediatric Neuroimaging

Slifer

Cataldo

et al. 1993

J of App Behav Analysis

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“…The choice of sedative agents used varies widely [11][12][13][14][15]. Chloral hydrate is the agent mainly used in our institution, as there is general consensus that it has a wide safety margin [1], though this practice may differ from that in the USA [9].…”

Section: Discussionmentioning

confidence: 99%

“…Chloral hydrate is the agent mainly used in our institution, as there is general consensus that it has a wide safety margin [1], though this practice may differ from that in the USA [9]. The dose used is variable but is usually between 50 and 100 mg.kg ¹1 ; doses up to 125 mg.kg ¹1 have been ........................................................................................................................................................................................................................................... reported [15]. The success rate of our oral sedation programme was 93%.…”

Section: Discussionmentioning

confidence: 99%

Structured sedation programme for magnetic resonance imaging examination in children

Keengwe

Hegde

Dearlove³

et al. 1999

Anaesthesia

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SummaryOne thousand, eight hundred and fifty-seven patients underwent magnetic resonance imaging following the establishment of a structured sedation programme. Forty-eight of these patients came from the intensive care unit with a secure airway and were therefore excluded from any further analysis. Oral sedation was to be given to children aged 5 years and below. For children Ն 6 years old, oral sedation could be given only if their level of co-operation was judged to be inadequate by the referring physician. Oral sedation consisted of chloral hydrate 90 mg.kg ¹1 (maximum 2.0 g) orally with or without rectal paraldehyde 0.3 ml.kg ¹1 . All magnetic resonance imaging requests for children who failed oral sedation as well as those referred for general anaesthesia from the outset were reviewed by a consultant anaesthetist who then allocated patients to undergo the procedure with either general anaesthesia or intravenous sedation. Scans requiring intravenous sedation or general anaesthesia were performed in the presence of a consultant anaesthetist. Intravenous sedation consisted of either a propofol 0.5 mg.kg ¹1 bolus followed by an infusion (maximum 3 mg.kg ¹1 .h ¹1 ) or midazolam 0.2-0.5 mg.kg ¹1 boluses. General anaesthesia was given using spontaneous ventilation with a mixture of 66% nitrous oxide in oxygen and isoflurane following either inhalation (sevoflurane) or intravenous (propofol) induction. One thousand and thirty-nine (57.4%) of the scans were done without sedation whereas 93 scans were performed during the consultant anaesthetist supervised sessions. Oral sedation failed in 50 out of 727 patients (6.9%). Eighty-seven per cent of children aged 5 years and below needed sedation compared with 4.5% of those aged over 10 years. Two patients who had only received chloral hydrate developed significant respiratory depression. This structured sedation programme has provided a safe, effective and efficient use of limited resources.

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“…Several sedation regimens based on inhalational or intravenous technique are available, and these have variable advantages and risks. 6,7 The purpose of this prospective observational study is to investigate the success of three different sedation regimens that are routinely used in our institution for pediatric sedation during MRI, including ketamine, propofol and sevoflurane, following midazolam premedication. Success was defined according immobility and need for additional anaesthetic.…”

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Sedation with Ketamine, Propofol or Sevoflurane for Pediatric Patients Undergoing Magnetic Resonance Imaging: An Observational Study

Altun¹,

Seyhan²,

Varansu³

et al. 2016

Turkiye Klinikleri J Anest Reanim

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A AB BS S T TR RA AC CT T O Ob bj je ec ct ti iv ve e: : Sedation is necessary frequently needed in children undergoing magnetic resonance imaging (MRI) to avoid motion. The purpose of present observational cross-sectional study is to investigate the success of three different sedation regimens including ketamine, propofol and sevoflurane in a mixture of 50% nitrous oxide-oxygen which are routinely used in our institution for pediatric sedation during MRI following midazolam premedication. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : Three hundred and seventy children (age 0-14 year) were enrolled to the study. Sedation was achieved in 125 children with ketamine, in 130 children with propofol and in 115 children with sevoflurane in a mixture of 50% nitrous oxide-oxygen. Comparison was performed among the groups for number of failures by excessive movements, numbers of rescue, adverse effects, sedation time and recovery time. Descriptive and parametric statistics (ANOVA) were utilized to look for significant differences. R Re es su ul lt ts s: : Children were similar in demographic characteristics. The comparison of three regimes in term of success according to the movements affecting imaging and requirement for rescue drug showed that minimal mobility which affects imaging and requires less rescue drug was achieved with sevoflurane in a mixture of 50% nitrous oxide-oxygen rather than propofol and ketamine. Although during MR imaging patients in Group ketamine required fewer numbers of rescue intervention to resolve the respiratory problems, desaturation by opening the airway by repositioning the head and neck and increasing the oxygen supply than the other two groups, rescue drug requirement was found more than Sevoflurane group. C Co on nc cl lu us si io on n: : In this study three different sedation regimens were compared according to the mobility which affects imaging and rescue for drug requirement and Sevoflurane in a mixture of 50% nitrous oxide-oxygen -based MRI sedation regimen in children is associated with lower movement, lower requirement for rescue drug, less side effects and higher success compared to ketamine and propofol. K Ke ey y W Wo or rd ds s: : Diffusion magnetic resonance imaging; conscious sedation; ketamine; propofol; sevoflurane Ö ÖZ ZE ET T A Am ma aç ç: : Çocuklarda Manyetik Rezonans (MR) çekimi sırasında hareketi önlemek amacıyla sıklıkla sedasyona ihtiyaç vardır. Bu gözlemsel kesitsel çalışmanın amacı, kurumumuzda MR görüntüleme esnasında midazolam premedikasyonunu takiben çocukların sedasyonunda rutin olarak kullandığımız Ketamin, Propofol ve Sevofluran+%50 nitröz oksit-oksijen kombinasyonu içeren üç farklı sedasyon rejiminin başarısını araştırmaktır. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Çalışmaya 0-14 yaş arası 370 çocuk dahil edildi. Oral midazolam premedikasyonunu takiben, çocukların 125'inde sedasyon iv. Ketamin (K), 130'unda iv. Propofol (P), ve 115'inde Sevofluran (S) + %50 nitröz oksit-oksijen kombinasyonu ile sağlandı. Gruplar arası karşılaştı...

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Sedation for Pediatric Patients Undergoing CT and MRI

Cited by 120 publications

References 0 publications

Behavior Analysis of Motion Control for Pediatric Neuroimaging

Behavior Analysis of Motion Control for Pediatric Neuroimaging

Structured sedation programme for magnetic resonance imaging examination in children

Sedation with Ketamine, Propofol or Sevoflurane for Pediatric Patients Undergoing Magnetic Resonance Imaging: An Observational Study

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