Sedation in pediatric CT: national survey of current practice.

Abstract

To document current sedation practices in computed tomographic (CT) examination of children, a questionnaire was sent to a random sample of 2,000 hospitals with CT scanners in the United States. Responses were received from 834 hospitals (42%). Of these, 450 were reported to conduct pediatric CT with sedation. Approximately one-half of the examinations were conducted in pediatric hospitals or medical schools. Most hospitals did not require signed consent for CT with light sedation, even when intravenously or orally administered contrast medium was used. Signed consent for CT with deep sedation was required in 62% of hospitals. Monitoring techniques and personnel present during CT with sedation varied greatly, as did oral intake protocols for examinations with oral contrast material or no contrast material. Use of intubation during CT with oral contrast medium was rare. Orally administered chloral hydrate was the most frequently used first-line drug for sedation in most types of CT studies. The great variation in practices indicates a lack of settled standards for sedation during pediatric diagnostic examinations. Many procedures reported for pediatric CT with sedation are at variance with recommendations of the American Academy of Pediatrics.

Structured sedation programme for magnetic resonance imaging examination in children

“…Keeter et al in a review of paediatric sedation practice for CT in the USA reported that more than 80% of toddlers were sedated for CT [9]. In our study, the need for sedation declined with increasing age, from 93% in those below 1 year to under 5% for those aged 11 years and above.…”

“…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].…”

“…This high standard of practice is not always achieved, as shown by a recent survey in Scotland [7]. Sedation programmes differ markedly, with varying organisational demands and cost implications [8][9][10]. However, the optimum level of organisation necessary to offer a safe and efficient MRI sedation service which is cost-effective is unclear, though recently there has been an increasing demand for a fully dedicated sedation team for MRI scanning.…”

Administration of oral chloral hydrate to paediatric patients undergoing magnetic resonance imaging

“…In a recent USA survey of current practice in sedation in paediatric computer tomography, Keeter et al report that chloral hydrate is the most commonly used sedative medication [23]. Fisher considers this is fortunate: although chloral hydrate frequently results in failed sedation, it is minimally toxic [24].…”

Intravenous Sedation vs General Anesthesia for Pediatric Otolaryngology Procedures

“…Pediatric sedation was first used widely to facilitate dental and oral surgery procedures [1][2][3] and to immobilize patients undergoing computed tomography or magnetic resonance imaging. 4,5 Subsequently, IVS has been increasingly used in the fields of pediatric oncology, 6,7 gastroenterology, 8 emergency medicine, 9,10 and several other specialties. To our knowledge, there has been no description of the use of IVS in the pediatric otolaryngology setting.…”