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I have found versed very unreliable in the usual IV, Nasal or Rectal
doses for
CT sedation in children older than a year or so. I have also seen a
higher
prevelance of emergence dysphoria than reported in most of the studies
on its use,
particularly in children over age two.
 
I have had great success over the past two years with Brevital 1 mg/kg
IV. I have
required repeat dosing in perhaps 1 in 50 cases, have never had an
airway problem
more severe than the need for transient jaw thrust O2 (and this is rare
in my experience).
 
Regarding the fasting, most patients in whom I am sedating for a CT have
not had a
large meal in the last two hours, or have already vomited, and so I am
not overly concerned
with this. I catch plenty of flack from anesthesiologist about this, as
well as JCAHO droids,
but the reality is I have never had an aspiration event in the six years
of sedating patients
daily for fracture reduction, suturing, dog-bite irrigation, etc. By the
way, for what it is worth-
there is beacoup data that this fasting dogma is yet another myth- see
Ingebo et al. Sedation in children:
adequacy of two-hour fasting. J Pediatr 1997;131:155-8. For anyone who
is interested, I have a brief review
of this paper on my website.
 
http://www.pediatric-emergency.com
 
 
Jay Fisher MD
UMC
University of Nevada SOM
Las Vegas NV
 
 
 
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?
>
> thanks
> Marianne Sutton, MD, MPH
>
> 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