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Personally, I like to use propofol in short procedures and for CT
scans. I have had very good results with it. In my residency, we had
a pt that we used chloral hydrate for sedation. There was a mix up in
the administration of the drug and the pt ended up getting about 1
1/2 the normal dose. Anyway, the pt developed ventricular arythmias
and ended up in the PICU for a week. We did a literature search and
found that this was not uncommon. Since then, I'm rather hesitant to
use it. I am still in training though and am always interested in
other options and opinions.

Megan Brown D.O.
Pediatric Emergency Medicine Fellow
Maimonides Medical Center



------------------ Reply Separator --------------------
Originally From: Rick Place MD <[log in to unmask]>
Subject:  sedation/ct for minor head trauma
Date: 11/19/2002 01:06am


I have been at several institutions in the past few years and seen
the entire
gamut. intravenous pentobarb seems to be the most reliable but
requires a
physician to be present. I have questions for the group for those who
use
other methods.

1. What do you use when chloral hydrate fails. The half life can be
fairly
long and I would be reluctant to begin piling on sedatives in this
setting.
Has anyone done this? Does anyone have experience using a second
agent with
chloral hydrate? How long would you wait?

2. Intravenous midazolam can also have either a paradoxical reaction
or else
require rather high doses in the already agitated child. How high do
you go
before you call it quits and move on to another agent? What would you
add.
The last time this happened I used a small (1mg/kg) dose of ketamine
for
imaging a neck abscess with nice results.

3. Those who use Pentothal regularly, have you had an problems with
adverse
effects other than some minor hypotension? It seems the most reliable
of the
agents but has the more concerning safety profile.

We use chloral hydrate at our facility currently but a few of us have
been
discussing other agents and it seems to me that pentobarb is the
obvious
choice.

Thanks

Rick Place
INOVA Fairfax Hospital
Falls Church VA

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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