In the past, I have had to use single agents for this: Ketamine, Etomidate, or Pentobarb.
Although there is concern for myoclonus with Etomidate interfering with CT scan, when pushed slowly myoclonus no longer becomes a concern. Invariably, pt's will become apneic with etomidate or pentobarb, but hypoxia can be mitigated with good preoxygenation and the apneic oxygenation technique (high flow nasal cannula). I much prefer Etomidate over pentobarb due to its quicker onset and shorter duration.
Weingart, S and Levitan, R. Preoxygenation and prevention of desaturation during emergency airway management. Ann Emerg Med. 2012 Mar; 59(3):165-175.
Samuel J. Prater, M.D.
Assistant Professor of Emergency Medicine
The University of Texas Medical School at Houston
Assistant Medical Director for Pediatric and Adult Trauma
Memorial Hermann Hospital Emergency Center- Texas Medical Center
From: Pediatric Emergency Medicine Discussion List [mailto:[log in to unmask]] On Behalf Of Angela Tangredi
Sent: Tuesday, April 23, 2013 11:45 AM
To: [log in to unmask]
Subject: sedation question
What does everyone use to sedate uncooperative toddlers for CT? We have to work around an anesthesia department that will not let us use propofol for sedation of young children. (And yes, I know we should be able to, but it is not a battle I can win at this time!!).
Angela Tangredi, MD
St. Luke's/Roosevelt Hospital Center
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