Abstracts of Posters; Presented at the International Anesthesia Research Society; 73rd Clinical and Scientific Congress; Los Angeles, CA; March 12-16, 1999: Pediatric Anesthesia
INTRODUCTION: Children frequently require sedation in order to be cooperative during magnetic resonance imaging (MRI) and computerized tomography (CT). We previously reported a 22% incidence of adverse events in children who underwent MRI or CT which included: respiratory depression (2%/2%; MRI/CT respectively), inadequate sedation (17%/14%) and failed sedation (9%/3%) . Furthermore, 2 cases of delayed oxygen desaturation have been reported in children who received chloral hydrate for diagnostic procedures . The purpose of this study was to describe the recovery and to determine the incidence of delayed adverse events in children after discharge home following sedation for MRI or CT.
METHODS: With IRB approval and parental informed consent, all children who received sedation for MRI or CT were prospectively studied. The following data were obtained during the procedure: medications administered, level of sedation, adverse events, and duration of recovery. Additionally, parents were telephoned the next day, and were asked to describe the following aspects of their child's recovery: wakefulness and activity, presence of side effects, need to call for medical advice, time of the child's return to baseline activity, and overall satisfaction with the sedation experience.
RESULTS: 193 patients (aged 3.6 +/- 3 yr.; 72% ASA I and 28% ASA II) underwent CT (11%) or MRI (89%) with sedation. Sedatives administered were chloral hydrate (CH; 64 +/- 15mg/kg) alone (85%), benzodiazepines alone (7%), and CH+ benzodiazepines (8%). Although discharge criteria were met in 27 +/- 15 minutes, parents reported that return to baseline activity was delayed in the majority of children [that evening (48%), the next day (45%), and later (7%)]. The adverse events are presented in Table 1.
Of the children in whom sedation was inadequate, 18 procedures failed, and 13 had to be rescheduled for general anesthesia (GA). Interestingly, children who experienced inadequate sedation returned to baseline activity later than those who were adequately sedated (p=0.02). In fact, one child whose sedation failed became excessively somnolent later that evening, and required admission to the emergency department. This child underwent an uneventful general anesthetic for the same procedure the following week. Lastly, 155 (80%) parents were somewhat to very satisfied with the sedation experience, while 20% were somewhat to very dissatisfied.
DISCUSSION: Our data indicate that sedation for MRI and CT procedures may be associated with delayed recovery particularly in children who experience inadequate sedation. The high incidence of imbalance after discharge underscore the need for close observation after discharge and specific discharge instructions regarding return to activities that require coordination.
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