A program to decrease the need for pediatric sedation for CT and MRI

Khan, Joseph J.; Donnelly, Lane F.; Koch, Bernadette L.; Curtwright, Lois A.; Dickerson, Julie M.; Hardin, Judy L.; Hutchinson, Sally A.; Wright, Jana; Gessner, Kevin E.

doi:10.37549/ar1505

Cited by 45 publications

(9 citation statements)

References 14 publications

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“…Finally, other methods that improve the sedation success rate without the administration of sedative agents have been reported 42 . These include restricting sleeping time on the night before the examination, 16 following the 2‐4‐6 rule, 28 preparing children, 43 and so on. Kimiya et al 16 and Masuda et al 28 mentioned that following the 2‐4‐6 rule will make parents set the time for their children to wake up and have breakfast, resulting in sleep restrictions.…”

Section: Discussionmentioning

confidence: 99%

Patient background related to success and adverse event in pediatric sedated MRI

Konda

Mihira

Akiyama

et al. 2022

Pediatrics International

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Background The success rate of sedation with triclofos sodium and midazolam for pediatric magnetic resonance imaging (MRI) has been reported. However, there are no reports of an association of adverse events and examination success rates with patient medical backgrounds using a combination of these sedatives. We performed this study to investigate these points. Methods We investigated 191 pediatric patients who were sedated for MRI with triclofos sodium and midazolam at Matsudo City Hospital between November 2013 and October 2015. We surveyed the patients' characteristics, including age, sex, body weight, allergies, medication, neuromuscular, gastrointestinal, respiratory, and cardiac disorders, airway obstruction factors, and developmental disorders. Outcomes were sedation success and adverse events, including oxygen desaturation. We reviewed the relationship between patient backgrounds and each adverse event or success rate of sedation. Results Among all cases, the success rate was 92.7%. Older age (odds ratio [OR] = 0.984), developmental disorders (OR = 0.215), and respiratory disorders (OR = 0.353) were factors for lower success rates. Adding midazolam was associated with a higher success rate (OR = 5.971), but the higher total dose of midazolam was associated with sedation failure (OR = 0.003). The only adverse event was oxygen desaturation (11.5%). Older age affected oxygen desaturation with multiple analysis. However, by stepwise analysis, no patient medical background nor sedative dose was associated with oxygen desaturation. Conclusions Older age, developmental disorders, and respiratory disorders were associated with sedation failure. Increasing midazolam did not increase the success rate, and there might be an optimal dose of midazolam.

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Section: Discussionmentioning

confidence: 99%

Patient background related to success and adverse event in pediatric sedated MRI

Konda

Mihira

Akiyama

et al. 2022

Pediatrics International

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“…Since as early as 1996, monitors displaying cartoons and videos have been used to help patients tolerate daily radiotherapy [40]. Moving light shows can be relaxing and distracting for younger patients [41]. More recently, headphones with music or stories and MR compat-ible video goggles have helped distract and comfort patients during their scans [33,36,42].…”

Section: Patient Education Training and Distractionmentioning

confidence: 99%

“…Khan et al evaluated sedation rates in pediatric CT and MRI scans before and after a sedation reduction program was implemented at the Cincinnati Children's Hospital Medical Center [41]. Six components were introduced sequentially over a 12 month period, though only three of them were MR compatible.…”

Section: Patient Education Training and Distractionmentioning

confidence: 99%

A Descriptive Review of the Impact of Patient Motion in Early Childhood Resting-State Functional Magnetic Resonance Imaging

et al. 2022

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Resting-state functional magnetic images (rs-fMRIs) can be used to map and delineate the brain activity occurring while the patient is in a task-free state. These resting-state activity networks can be informative when diagnosing various neurodevelopmental diseases, but only if the images are high quality. The quality of an rs-fMRI rapidly degrades when the patient moves during the scan. Herein, we describe how patient motion impacts an rs-fMRI on multiple levels. We begin with how the electromagnetic field and pulses of an MR scanner interact with a patient’s physiology, how movement affects the net signal acquired by the scanner, and how motion can be quantified from rs-fMRI. We then present methods for preventing motion through educational and behavioral interventions appropriate for different age groups, techniques for prospectively monitoring and correcting motion during the acquisition process, and pipelines for mitigating the effects of motion in existing scans.

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“…Aside from the increased risk to the patient, sedation and anesthesia can lead to additional resource requirements, system impacts, and costs of care that are reported to be 3.24–9.56 times higher for sedated patients [ 4 ]. Alternative methods of preparing children for MRI exist and can decrease the frequency of sedation by up to 34.6% [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Economic Evaluation Comparing Virtual Reality with Child Life Programming for Non-sedated Pediatric Medical Imaging: A Cost-Consequence Analysis

Jacob

Stunden

Deenadayalan

et al. 2023

PharmacoEconomics Open

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Introduction Effective preparation of children for hospital procedures, including non-sedated medical imaging, is an important clinical issue. This study aimed to assess the costs and consequences (effects) of preparing pediatric patients using two methods of delivering preparation for a scheduled magnetic resonance image (MRI)—virtual reality (VR-MRI) and a certified Child Life Program (CLP). Methods A cost-consequence analysis (CCA) was performed using a societal perspective in Canada. The CCA catalogs a wide range of costs and consequences of VR-MRI compared with a CLP. The evaluation uses data from a prior randomized clinical trial evaluating VR and a CLP in a simulated trial. The economic evaluation encompassed health-related effects, including anxiety, safety and adverse events, and non-health effects, including preparation time, displaced time from usual activities, workload capacity, patient-specific adaptation, administrative burden, and user-experience metrics. The costs have been categorized into hospital operational costs, travel costs, other patient costs, and societal costs. Results VR-MRI has similar benefits to the CLP in managing anxiety, safety and adverse events, as well as converting patients to non-sedated medical imaging. Preparation time and patient-specific adaptation are in favor of the CLP, while displaced time from usual activities, potential workload capacity, and administrative burden are in favor of VR-MRI. Both programs rank favorably in terms of user experience. The hospital operational costs ranged in Canadian dollars (CAN$) from CAN$32.07 for the CLP to between CAN$107.37 and CAN$129.73 for VR-MRI. Travel costs ranged from CAN$50.58 to CAN$2365.18 depending on travel distance for the CLP, and CAN$0 for VR-MRI. Other patient costs involved caregiver time off, and ranged from CAN$190.69 to CAN$$1144.16 for the CLP and CAN$47.67 for VR-MRI. The total cost for the CLP ranged from CAN$315.16 (CAN$277.91–$426.64) to CAN$3843.41 (CAN$3196.59–$4849.91) per patient depending on travel distance and amount of administrative support required, while VR-MRI preparation ranged from CAN$178.30 (CAN$178.20–$188.76) to CAN$283.85 (CAN$283.71–$298.40) per patient. For every instance where patient travel to visit a Certified Child Life Specialist (CCLS) onsite was replaced with VR-MRI, between CAN$119.01 and CAN$3364.62 total costs could be saved per patient. Conclusions While it is neither feasible nor appropriate to replace all preparation with VR, using VR to reach children who cannot otherwise visit the CLP onsite could increase access to quality preparation, and using VR in place of the CLP where clinically indicated could reduce the overall costs for patients, the hospital, and society. Our CCA gives decision makers a cost analysis and the relevant effects of each preparation program so they can value the VR and CLP programs more broadly within the potential health and non-health outcomes o...

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A program to decrease the need for pediatric sedation for CT and MRI

Cited by 45 publications

References 14 publications

Patient background related to success and adverse event in pediatric sedated MRI

Patient background related to success and adverse event in pediatric sedated MRI

A Descriptive Review of the Impact of Patient Motion in Early Childhood Resting-State Functional Magnetic Resonance Imaging

Economic Evaluation Comparing Virtual Reality with Child Life Programming for Non-sedated Pediatric Medical Imaging: A Cost-Consequence Analysis

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