Sedation of neurologically impaired children undergoing MRI: a sequential approach

Abstract

Administering up to 1.5 g of chloral hydrate without supplementation was associated with a failure rate of approximately 20%, but the proposed sequential approach enabled us to rescue the majority of failed sedations while maintaining an acceptably low incidence of adverse events.

Early experience with remote pressure sensor respiratory plethysmography monitoring sedation in the MR scanner

“…Since calibration procedures used for quantitative respiratory plethysmography are unlikely to be applicable in the context of paediatric sedation, techniques such as RPSRP are not viable to obtain quantitative volume measurements. In this sample of 27 patients, four received intraprocedural supplementation after motion artefacts appeared; when compared to the results reported in [8] this may seem a surprisingly high proportion. The cause is that, while in the period under consideration in this study, intra-procedural supplementation was performed as soon as artefacts appeared, in [8] a different policy was adopted, which was attempted to continue imaging without intervention, and all those cases in which movements were transitory and imaging could be completed were not counted.…”

“…STP (3.1-4.9 mg kg 21 ) directly, due to availability of venous access. While in [8], a strict policy of not administering any medication in the magnet room was envisaged, in the period under consideration in this study, we performed intra-procedural supplementation as soon as motion artefacts appeared on imaging. In this framework, two patients from the CF group and two patients from the NC group received intra-procedural supplementation of i.v.…”

“…supplementation of 10 mg boluses of sodium thiopental (STP, 1.4-4.1 mg kg 21 ) titrated to reach the desired sedation score [19]. This sedation protocol is described in detail in [8]. The remaining 13 patients (no chloral, NC group) were sedated with i.v.…”

“…Although the incidence of upper airway obstruction is increased by the use of intravenous (i.v.) medications, it is not negligible even when drugs considered relatively safe such as oral chloral hydrate are used [8].…”

“…Furthermore, obstructions of the sampling line due to secretions and moisture can occur, especially in infants, and, although inserting the PETCO 2 probe in a facial mask may circumvent these problems, it is often not possible when a head coil is to be used [5][6][7][8].…”