Abstracts of Posters Presented at the International Anesthesia Research Society; 72nd Clinical and Scientific Congress; Orlando, FL; March 7-11, 1998: Pediatric Anesthesia
Introduction: Sedation for diagnostic procedures outside the operating room has increased dramatically over the past decade. Magnetic resonance (MR) imaging requires a high degree of immobility, often necessitating sedation in children. This study compares the sedation of children for MR imaging by nurses versus anesthesiologists.
Methods: A retrospective chart review was performed for all children who were sedated for MR imaging from January 1996 to December 1996 at Lucile Salter Packard Children's Hospital at Stanford. Both inpatients and outpatients were included in the study. Conscious Sedation Service (CSS) was provided by a registered nurse who sedated two children per day for five days a week. The nurse utilized pentobarbital intravenously or chloral hydrate orally or rectally. The cases were scheduled through the CSS office and pre-screened by the nurse providing conscious sedation. Sedation by anesthesiologists was scheduled if a child was believed to be a poor candidate for conscious sedation or if a history of difficult sedation or sedation failure was clicited. Sedation by anesthesiologists for routine cases was scheduled for one-half-day per week; sedation for emergent cases was available on demand. Anesthesiologists used continuous intravenous infusion of propofol with supplemental oxygen by nasal cannula or with laryngeal mask airway. Immediately upon completion of MR scanning, the patients were transferred to the postanesthesia care unit for recovery. MR compatible monitoring equipment, including pulse oximetry, capnography, electrocardiogram, and non-invasive blood pressure measuring device, were similar for both sedation services.
Results: Out of a total of 530 casas, nurses sedated 483 (91%), and anesthesiologists sedated 47 (9%). No major complications nor unexpected hospital admissions occurred during the study period for both sedation services. The results are summarized in Table 1. The failure rate for sedation was 5% for nurses and 0% for anesthesiologists.
Discussion: In our study, nurses provided sedation for routine cases, and anesthesiologists provided sedation for more difficult cases. Children sedated by nurses represented a younger patient population compared with children sedated by anesthesiologists. Sedation by nurses was safe and effective with a higher failure rate of 5% versus 0% for anesthesiologists. This 5% failure rate is comparable to rates reported in the literature.  Sedation failures are costly in terms of wasted MR scanner time and parental absence from work. In our current practice environment, nurses and anesthesiologists play complementary roles in providing sedation for children undergoing procedures outside the operating room. However, existing guidelines for sedation of children  and sedation by non-anesthesiologists  must be followed.
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