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?



"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
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