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

Abstract

At the dosing used in this study, pentobarbital is superior to etomidate when comparing success rates for sedation. However, among the successful sedations, the duration of sedation was shorter in the etomidate group than in the pentobarbital group. Pentobarbital is associated with more frequent side effects and parental concerns compared to etomidate.

Comparison of Propofol With Pentobarbital/Midazolam/Fentanyl Sedation for Magnetic Resonance Imaging of the Brain in Children

“…This was consistent with the dose used in 2 previous studies 22,24 and higher than the 5 mg/kg used in 2 other trials. 21,36 In contrast, 1 previous study used a maximum dose of 6.5 mg/kg of pentobarbital. 37 Furthermore, the method of administration of pentobarbital in our study was an initial bolus of 2 mg/kg followed by additional aliquots of 1 mg/kg until adequate sedation was achieved.…”

“…22,24 Others used a smaller dose for subsequent boluses ranging from 1 to 2 mg/kg aliquots of pentobarbital. 20,21 It is possible that the relatively smaller incremental doses of pentobarbital used in our study may have led to a bias in favor of the propofol group.…”

“…Secondary outcome measures were IT, TST, quality of imaging, number of repeat image sequences, frequency of immediate and delayed adverse events, sedation success or failure, caregiver satisfaction, and caregiver report of TTB. According to Kienstra et al 21 and Mason et al, 20 the standard deviation for the RT in the pentobarbital group was 32 minutes. From Hasan et al, 30 the standard deviation for the RT in the propofol group was 21 minutes.…”

“…[15][16][17] Pentobarbital, a shortacting barbiturate, has a proven record of safety and efficacy when used with midazolam or fentanyl for sedation during pediatric diagnostic imaging. 14,[18][19][20][21][22] The overall incidence of inadequate or failed sedation during imaging procedures in children varies widely from 1% to 16%. 21,[23][24][25] We are not aware of any prospective, randomized clinical trial comparing deep sedation with propofol versus pentobarbital for pediatric MRI.…”

Intranasal Dexmedetomidine for Sedation for Pediatric Computed Tomography Imaging

“…Currently, oral chloral hydrate and intravenous (IV) propofol and pentobarbital are the most commonly used sedation medications for CT imaging. [1][2][3][4][5] Dexmedetomidine (DEX) (Precedex; Hospira, Lake Forest, Illinois) was approved in 2008 by the Food and Drug Administration as an IV sedative for procedures outside of the intensive care unit. 6 The present prospective observational study evaluated the efficacy, image quality, and outcomes of aerosolized intranasal (AIN) DEX as the sole sedative for CT sedation.…”