Comparison of Intravenous Midazolam with Pentobarbital for Sedation for Head Computed Tomography Imaging

Abstract

Abstract. Objective:To compare the efficacy of intravenous (IV) midazolam with that of IV pentobarbital when used for sedation for head computed tomography (CT) imaging in emergency department (ED) pediatric patients. Methods: Prospective, randomized clinical trial in an urban children's hospital. During a two-and-a-half-year period, 55 patients were enrolled: 34 males and 21 females. Measurements included induction time, recovery time, efficacy, side effects, complications, and failure with each drug. Success of sedation was graded as good (GS), adequate (AS), poor (PS), or unsuccessful (US). Results: Sedation for CT was used for patients with the following problems: head trauma (21/55), central nervous system pathology (17/55), ventriculoperitoneal shunt evaluation (6/55), periorbital cellulitis (6/55), and retropharyngeal abscess (5/55). Twenty-nine (53%) patients received pentobarbital (mean Ϯ SD dose 3.75 Ϯ 1.10 mg/kg) and 26 (47%) patients received midazolam (mean Ϯ SD dose 0.2 Ϯ 0.03 mg/ kg). In the pentobarbital group, 28 (97%) patients were scanned and successfully sedated. Pentobarbital's mean induction time was 6 minutes and duration of sedation averaged 86 minutes. In the midazolam group, only five (19%) patients were successfully scanned with midazolam alone. Of the 21 (81%) patients given midazolam who were unsuccessfully sedated, 12 (61%) were subsequently sedated with the addition of pentobarbital for completion of CT imaging. Mild oxygen desaturation, O 2 sat >90% yet <94%, was seen in only four patients. All four patients responded to blow-by oxygen and required no other intervention. Conclusion: Intravenous pentobarbital is more effective than IV midazolam for sedation of children requiring CT imaging.

Etomidate Versus Pentobarbital for Sedation of Children for Head and Neck CT Imaging

“…Further studies of pentobarbital sedation for CT scans in children have shown the mean induction times (time from administration to achievement of sufficient sedation to perform the scan) to range from 6 to 8.1 minutes and the mean sedation time (time from induction to discharge) to range from 56 to 86 minutes. 9,10 The use of a sedative agent with a shorter duration of action should improve efficiency in radiology departments and shorten patient recovery time. Furthermore, with the advent of helical CT scanners, the time required to perform CT scans (table times) has been markedly reduced.…”

Comparison of Dexmedetomidine With Pentobarbital for Pediatric MRI Sedation

“…20 Although it has an established record of safety and effectiveness and has been demonstrated to be superior to sedatives such as chloral hydrate and midazolam, [21][22][23] its sedation time is long (80-100 minutes). 22 This length of time might be related to the relatively large dose of the drug needed to induce an immobile state. It is usually longer than the time needed for most radiologic procedures, including MRI.…”

Deep sedation in pediatric imaging: efficacy and safety of intravenous chlorpromazine

“…With a success rate of 96%, our results favorably compare with the results reported with other techniques. Indeed, since the introduction of modern imaging (CT and MRI), radiologists and pediatricians have attempted to determine the most effective and safest sedation strategy [14][15][16][17], barbiturates (pentobarbital [5,11,18], methohexital [19][20][21] or thiopental [22][23][24]) and a number of other compounds like chloral hydrate [6,18,25], etomidate [26] and propofol [4,27,28] have been tested (Table 6). With these protocols, sedation has been reported to be effective in 80-100% of patients.…”