The choice of sedation for computed tomography in children: a prospective evaluation.

Abstract

A prospective study of 582 pediatric cranial computed tomographic (CT) examinations was made in order to determine the efficacy and safety of two sedation regimens and general anesthesia. Two hundred seventy-nine outpatients were randomly given oral chloral hydrate (80 mg/kg) or an intramuscular preparation composed of atropine, meperidine, promethazine, and secobarbital (AMPS). Three hundred three inpatients were randomly administered chloral hydrate, the AMPS, or endotracheal anesthesia. Intravenous supplementation of the sedation was limited by the protocol to a maximum secobarbital dosage of 2 mg/kg. An additional retrospective analysis was made of 316 scan attempts obtained outside the study during the same period. A failed CT examination was defined as one that could not be completed or one that showed motion artifacts on two or more scan pairs after two scan pair repeats. The failure rate was 15% for the chloral hydrate group and 12% for the AMPS group. No motion artifacts were present on 94% of the completed studies. There was no mortality, but major and minor complications occurred in 3.5% of the randomized group. It was concluded that each of the methods had proved acceptably safe and effective and that measures can be taken to decrease complications and sedation failures further.

Administration of oral chloral hydrate to paediatric patients undergoing magnetic resonance imaging

“…No significant differences in sleep induction time were found for sex and diagnostics. In a study developed by Thompson et al [3], the average time of onset of sedation was considerably longer (55 min).…”

“…Many drugs have been used at different doses and by different administration routes to produce sedation or sleep: chloral hydrate [1][2][3][4][5][6][7][8], meperidine, promethazine and chlorpromazine (the DPT, MPC or 'lytic' cocktail) [2 9-11], atropine, meperidine, promethazine and secobarbital (the AMPS cocktail) [3], barbiturates [4 9 12-14] or benzodiazepines [15][16][17][18]. However, these drugs can cause serious toxicity and are not consistently effective in all patients [19 20].…”

Monitoring End-Tidal Carbon Dioxide Levels of Deeply Sedated MRI Pediatric Patients During the Recovery Period

“…Intravenous pentobarbital is widely used in radiology departments for sedating pediatric patients who are undergoing imaging studies (Chung, Hoffer, Connor, Zurakowski, & Burrows, 2000;Hart et al, 1997;Mason, Connor, Burrows, Zurakowski, & Krauss, 2001;McQuillen & Stele, 2000;Thompson, Schneider, Holden, Hinshaw, & Hasso, 1982;Tobias, 1999). Potential adverse events associated with pentobarbital can include laryngospasm, respiratory depression, apnea (especially with rapid IV use), arrhythmia, bradycardia, hypotension, and central nervous system excitation or depression (AAP, 1992;ASA, 2005;Cauldwell, 2002;Connor et al, 2003;Joint Commission Resource, 2001;Nobel, 1996;Tobias, Flanagan, Wheeler, Garrett, & Burney, 1994).…”

Assessment of the effect of head and neck position on upper airway anatomy in sedated paediatric patients using Magnetic Resonance Imaging

“…However, sedation is usually necessary to ensure that they remain motionless. Sedative agents which have been used for this purpose include intravenous pentobarbital (Strain et al 1986(Strain et al , 1988, oral chloral hydrate (Greenberg et al 1993(Greenberg et al , 1994, thioridazine (Greenberg et al 1994), rectal or intramuscular methohexital (Schoch et al 1990; Manuli & Davies 1993), rectal thiopentone (White et al 1979), combinations of atropine, meperidine, promethazine and secobarbital (Thompson et al 1982), meperidine, chlorpromazine and promethazine (Anderson & Osborn 1977), or nasal kdazolam and ketamine (Louon & Reddy 1994). In this study, intravenous pentobarbital, titrated to effect was used to induce sedation.…”