Trained nurses can provide safe and effective sedation for MRI in pediatric patients

Abstract

Purpose: To determine the success rate, safety and complications using a standard protocol and trained nurses to provide sedation for MRI under the supervision of a radiologist. Materials and Methods:Nurses were trained to provide sedation via a standard protocol for pediatric patients undergoing diagnostic MRI. Oral chloral hydrate (80-100 mg·kg -1 ) was used for children less than 18 mo of age. Older children received either 1-6 mg·kg -1 pentobarbital iv, with or without 1-2 µg·kg·hr -1 fentanyl, or 25 mg·kg -1 thiopental pr. Sedation was defined as successful if it allowed completion of the MRI without image distorting patient movement. The records of 572 MRIs performed on 488 pediatric patients (mean age 5 ± 4 yr; age 2 mo-14 yr) from 1991 to July 1995 were reviewed to determine the success rate and complications using the sedation program.Results: Most, 91.8% (525/572), of the MRIs were successfully completed in 445 patients. The reasons for failure were inadequate sedation (45, 95.7%) and coughing (2, 4.2%). The failure rate was much higher before 1994 (38/272, 14%) than after (9/300, 3%; P < 0.0001). Failure was more common if rectal thiopental was used (23/172, 14%) than intravenous pentobarbital (19/256, 7.4%; P < 0.05). The failure rate was also high in patients with a history of a behavioural disorder (10/59,17%). There were no deaths or unexpected admissions as a result of the sedation program. Conclusion:A high success rate can be achieved as experience is gained using a standard protocol and trained nurses to sedate children for MRI. Méthode : Des infirmières ont été formées pour administrer la sédation selon un protocole standard à des patients pédiatriques devant subir un examen diagnostique d'IRM. L'hydrate de chloral oral (80-100 mg·kg -1 ) a servi pour les enfants de moins de 18 mois. Les plus âgés ont reçu soit 1-6 mg·kg -1 de pentobarbital iv, avec ou sans 1-2 µg·kg·hr -1 de fentanyl, soit 25 mg·kg -1 de thiopental pr. On considérait la sédation réussie quand l'IRM était achevé sans distorsion d'image par un mouvement du patient. Les enregistrements de 572 IRM réalisés chez 488 enfants (âge moyen de 5 ± 4 ans; limite d'âge de 2 mois-14 jrs) de 1991 à juillet 1995 ont été revus pour l'évaluation du taux de succès et des complications liés au programme de sédation.Résultats : La plupart des examens d 'IRM, 91,8 % (525/572), ont été réalisés avec succès chez 445 patients. Les échecs ont eu pour cause une sédation insuffisante (45, 95,7 %) et la toux (2, 4,2 %). Le taux d'échec a été beaucoup plus élevé avant 1994 (38/272, 14 %) qu'après (9/300, 3 %; P < 0,0001). L'échec était plus fréquent avec l'usage de thiopental rectal (23/172, 14 %) qu'avec le pentobarbital intraveineux (19/256, 7,4 %; P < 0,05). Le taux d'échec a été élevé également chez les patients qui présentaient des antécédents de troubles de comportement (10/59, 17 %). Aucun cas de décès ou d'admission imprévue n'a résulté de ce programme de sédation.Conclusion : Un fort taux de réussite peut être atteint à mesure que se développe l...

A pediatric sedation/anesthesia program with dedicated care by anesthesiologists and nurses for procedures outside the operating room

“…7 The level of skill and autonomy of the practitioner administering the sedation has not been assessed as a causative factor of failure, although in many protocols, if a nurse alone is administering sedation without further backup, both the doses of drugs and the use of drug combinations may be limited. 19,21 These limitations are justified as even triclofos sodium used alone can cause respiratory depression in sufficient dose and more so when combined with other drugs. 17,22,23 The protocol suggested in the present study addresses these issues as it provides both a rigid set of rules for the administration of sedation by a nurse and the flexibility of an anesthesiologist ''on call'' who is able to escalate sedation both in terms of drugs and doses until adequate conditions are achieved.…”

Sedation for radiological imaging

“…Failure of sedation rates have varied from 0% to 20% 4–7 10. A study in the UK showed the success rate in those that weighed 5 to 15 kg was 97% but that failure rate increases with age, with a failure rate of 26% in the 6- to 11-year-olds 5.…”

“…It can be given intravenously, intramuscularly and orally. As a sole agent, it has a good success rate of 91% to 99% 8–10 27. The oral solution contains 50 mg/ml and is cherry flavoured.…”

L’administration d’une sédation sécuritaire et efficace à des enfants en IRM par des infirmières spécialisées

“…2,5,6 Success rates of 92-95% have been achieved. This has been due to strict selection criteria, 5 4 Children have a wide drug dosage range for attaining therapeutic effects, and at sub-optimal drug levels, this can blunt negative inhibition and the child can be more difficult to manage.…”

“…2,5,6 Les taux de succès variaient de 92 à 95 %. On les doit à des critères de sélection rigoureux, 5 au monitorage continu de la saturation en oxygène et à l'imposition d'une limite maximale de la dose de médicament.…”