Structured sedation programme for magnetic resonance imaging examination in children

• Published in: Anaesthesia Vol. 54; no. 11; pp. 1069 - 1072
• Main Authors: Keengwe, I. N., Hegde, S., Dearlove, O., Wilson, B., Yates, R. W., Sharples, A.
• Format: Journal Article
• Language: English
• Published: Oxford Blackwell Science Ltd 01-11-1999; Blackwell
• Subjects: Adolescent; Adult; Anaesthesia; paediatric; Anesthesia; Anesthesia depending on type of surgery; Anesthesia, General - statistics & numerical data; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Child; Child, Preschool; Conscious Sedation - statistics & numerical data; Humans; Infant; Investigative techniques, diagnostic techniques (general aspects); Magnetic Resonance Imaging; Measurement techniques; magnetic resonance imaging; Medical sciences; Miscellaneous. Technology; Orthopedic surgery. Maxillofacial surgery. Otorhinolaryngologic surgery. Stomatology. Ophtalmology. Investigation and treatment technics; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Sedation; Treatment Outcome; Human; Intravenous administration; Oral administration; Medical imagery; General anesthesia; Infant; Sedative; Sedation; Child; Nuclear magnetic resonance imaging
• ISSN: 0003-2409; 1365-2044
• DOI: 10.1046/j.1365-2044.1999.01106.x

One thousand, eight hundred and fifty‐seven patients underwent magnetic resonance imaging following the establishment of a structured sedation programme. Forty‐eight of these patients came from the intensive care unit with a secure airway and were therefore excluded from any further analysis. Oral sedation was to be given to children aged 5 years and below. For children ≥ 6 years old, oral sedation could be given only if their level of co‐operation was judged to be inadequate by the referring physician. Oral sedation consisted of chloral hydrate 90 mgkg−1 (maximum 2.0 g) orally with or without rectal paraldehyde 0.3 ml.kg−1. All magnetic resonance imaging requests for children who failed oral sedation as well as those referred for general anaesthesia from the outset were reviewed by a consultant anaesthetist who then allocated patients to undergo the procedure with either general anaesthesia or intravenous sedation. Scans requiring intravenous sedation or general anaesthesia were performed in the presence of a consultant anaesthetist. Intravenous sedation consisted of either a propofol 0.5 mgkg−1 bolus followed by an infusion (maximum 3 mgkg−1.h−1) or midazolam 0.2–0.5 mgkg−1 boluses. General anaesthesia was given using spontaneous ventilation with a mixture of 66% nitrous oxide in oxygen and isoflurane following either inhalation (sevoflurane) or intravenous (propofol) induction. One thousand and thirty‐nine (57.4%) of the scans were done without sedation whereas 93 scans were performed during the consultant anaesthetist supervised sessions. Oral sedation failed in 50 out of 727 patients (6.9%). Eighty‐seven per cent of children aged 5 years and below needed sedation compared with 4.5% of those aged over 10 years. Two patients who had only received chloral hydrate developed significant respiratory depression. This structured sedation programme has provided a safe, effective and efficient use of limited resources.