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Dear colleague,

I thought we had difficult anesthetists, but "nothing compares to you".
No, we have not such a policy and even if we had, it would maximally be
4 hours. Specifically for the appendicitis situation, we don't use CT.
Can you direct me to some scientific evidence about sensitivity and
specificity of that method?

Thanks,

Nikolaus

"Loren Yamamoto, MD, MPH" wrote:
>
> The anesthesia department in our hospital, has proposed a study limiting
> the use of oral CT contrast for pediatric patients who may require
> sedation for the CT scan procedure.  This occurs frequently in young
> children with the possibility of appendicitis in whom we'd like to rule
> out appendicitis.  The proposed policy requires that patients be NPO (ie.,
> no oral contrast) for 6 hours prior to sedation (this delays the
> diagnostic procedure and the GI contrast may have passed too far).
> Otherwise, the patient must be intubated and have sedation conducted by an
> anesthesiologist during the CT procedure (this would be excessively
> expensive and anesthesia frequently is unavailable).  Does any other
> hospital have a similar policy restricting oral CT contrast use in
> pediatric patients requiring sedation?  If you have no such policy, please
> send me an e-mail indicating that you have no such policy.  If you have a
> similar or alternative policy, please send me an e-mail describing the
> policy.  Thank you very much.
>         Understandably, alternatives include 1) rectal contrast, 2)
> ultrasound, or 3) we could purchase a GE light speed CT scanner so the
> need for sedation will be minimized.   However, 1) Our radiologists don't
> like giving rectal contrast.  2) Ultrasound does not always visualize the
> appendix.  Additionally at night, the on-call radiologist may not have the
> degree of ultrasound experience that I feel comfortable with.  To prevent
> calling in the ultrasound tech and then later the CT tech, I've resorted
> to ordering a CT scan as the imaging method of choice during the night
> shift.  3) We cannot afford a new CT scanner at this time.
>
> Sincerely,
> Loren Yamamoto, MD, MPH
> Emergency Dept.
> Kapiolani Medical Center For Women and Children
> Honolulu, HI
>
> For more information, send mail to [log in to unmask] with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>   http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html

For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
  http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html