Midazolam is a great anxiolytic in older children but a poor
hypnotic. For the anxious 8 y/o would be a good choice for CT. Chloral
hydrate (orally) seems pretty reliable as a hypnotic in infants and young
toddlers. I use 60 mg/kg under 6 months and 75 mg/kg over 6 months.
BUT, due to high failure rate of chloral hydrate 18 mo and over my
preference is IV pentobarbital.The protocol suggested by John Strain works
well (take syringe of 5 mg/kg to CT, administer 1/2 of total, wait,
administer 1/2 of remainder, wait, then administer remainder). Problems
include...pain and crying associated with injection of pentobarb,
occasional post-hyperventilation desaturation, occasional airway
obstruction, prolonged DEEP sedation if whole 5 mg/kg dose is given. IV
nembutal is NOT conscious sedation. For more info I suggest reviewing
several series in the radiology literature ...
The NPO issue is a big problem ... one can make a good case for
intubation in those patients who need truely emergent CT. I usually regret
trying to "sedate" someone who is agitated/combative due to the injury as
opposed to a toddler who is appropriately combative.
Strain JD, Harvey LA, Foley LC, Campbell JB. Intravenously administered
pedntobarbital sodium for sedation in pediatric CT. Radiology 161:105-108,
Strain JD, Campbell JB, Harvey LA, Foley LC. IV Nembutal: Safe sedation
for children undergoing CT. AJR 151:975-979, 1988.
Hubbard AM, Markowitz RI, Kimmel B, et al. Sedation for pediatric patients
undergoing CT and MRI. J Computer Assisted Tomography 16(1):3-6, 1992.
At 12:25 PM -0500 2/2/98, Marianne B. Sutton wrote:
>I work in a Community Hospital in Massachussets we use versed for
>conscious sedation frequently and had a few questions.
>What are people doing when sedation for a CT with versed fails?
>Are non-anesthesiologists using propofol (diprivan)?
>Do you give versed to children who have a full stomach? If now how long
>do you require them to be NPO?
>Marianne Sutton, MD, MPH
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