Sedation/anaesthesia in paediatric radiology

Abstract

Objectives In this article we will give a comprehensive literature review on sedation/general anaesthesia (S/GA) and discuss the international variations in practice and options available for S/GA for imaging children. Methods The key articles were obtained primarily from PubMed, MEDLINE, ERIC, NHS Evidence and The Cochrane Library. Results Recently, paediatric radiology has seen a surge of diagnostic and therapeutic procedures, some of which require children to be still and compliant for up to 1 h. It is difficult and sometimes even impossible to obtain quick and high-quality images without employing sedating techniques in certain children. As with any medical procedure, S/GA in radiological practice is not without risks and can have potentially disastrous consequences if mismanaged. In order to reduce any complications and practice safety in radiological units, it is imperative to carry out pre-sedation assessments of children, obtain parental/guardian consent, monitor them closely before, during and after the procedure and have adequate equipment, a safe environment and a well-trained personnel. Conclusion Although the S/GA techniques, sedative drugs and personnel involved vary from country to country, the ultimate goal of S/GA in radiology remains the same; namely, to provide safety and comfort for the patients. Advances in knowledge Imaging children under general anaesthesia is becoming routine and preferred by operators because it ensures patient conformity and provides a more controlled environment.

Paediatric sedation for imaging is safe and effective in a district general hospital

“…2,28,37 Currently, there is no consensus on the optimum sedation practice for use in imaging. 38 Good practice should include but is not limited to: adequate pre-assessment, written consent, appropriate fasting, sleep deprivation, use of trained staff during sedation, understanding the pharmacokinetics and dynamics of prescribed sedative agents, availability of emergency equipment, frequent observations and appropriate discharge.…”

“…1 With MR and nuclear medicine (NM) scans, the time taken is longer, typically between 30 and 60 min. 2,3 There are a number of methods which can be employed to limit the movement of the child during a scan.…”

“…The level of sedation can be categorized as per the American Society of Anesthesiologists. 8 These levels include (1) minimal sedation (anxiolysis), (2) moderate sedation/analgesia (conscious sedation), (3) deep sedation/analgesia and (4) GA. With each level of sedation, there is a decrease in the child's response, airway protection and an increasing need for cardiovascular support. The important distinction between these states revolves around the child's ability to maintain protective reflexes.…”

Rapid lung MRI - paradigm shift in evaluation of febrile neutropenia in children with leukemia: a pilot study

“…Adequate sedation is important to avoid repeat imaging and poor image quality due to movement which might Leuk Lymphoma Downloaded from informahealthcare.com by Fudan University on 05/15/15 13 make the study futile. Sedation exposes these children to risks associated with sedation / anaesthesia, besides increase in time, and cost of the procedure, and need for post procedure monitoring [16]. Our total scan time for all four sequences combined was only 2 minutes.…”

Quiet T1-Weighted Pointwise Encoding Time Reduction with Radial Acquisition for Assessing Myelination in the Pediatric Brain

“…Consequently, the application of MR imaging is limited in infants and small children, who often need sedation to undergo MR imaging. [3][4][5] Even under sedation, the acoustic noise from MR imaging can make children restless or cause them to awaken, resulting in severe motion artifacts or incomplete examinations.…”