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Mike - I am curious about your choice of chloral hydrate - I thought
that the drug had a variable effect with occasional paradoxical
excitement and the disadvantage of a prolonged action.
 
I also thought that the absorption of rectal midazolam is very variable
producing inconsistent results with occasional paradoxical excitement.
 
Why not use pentobarbital IM (or IV) for all cases if it is consistently
effective? Is there not a small (but significant) risk of  severe
respiratory respiratory depression associated with the use of larger
doses of IM pentobarbital (5mg/kg)? When do you think that it is safer
to titrate small IV doses of pentobarbital under controlled observation
(compared to a single dose IM)? How does pentobaribital compare to
propofol IV or methohexital IV or midazolam IV, and what dose range
would you recommend for these other agents?
 
Also, I thought that IM midazolam was well absorbed and nearly as
consistently effective as IV midazolam - is that correct?
 
Jeff.
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Date:    Mon, 30 Aug 1999 14:02:58 EDT
From:    "Michael Gerardi, M.D., FAAP, FACEP" <[log in to unmask]>
Subject: Re: Head CT
 
Hello Gang.
 
When slam-dunk sedation is needed - i.e. - no movement and guaranteed
hypnosis so the techs don't start playing ping-pong with the child - I
use
pentobarbital 4-5 mg/kg IM as Jay wrote. It has always worked and I send
a
PALS certified nurse(someone I trust) to bag the child if they
desaturate
(which has never happened but it would if I didn't send a nurse).
 
When it is evening when childen are close to bed-time, low risk head
injury,
CYA scan and I can tolerate a little motion artifact, this Cro-magnon
man
still uses chloral hydrate 25-75 mg/kg po - works almost all the time.
 
I a proponent of rectal midazolam (0.5-0.7mg/kg) as long as it is
absorbed by
mucosa and not stool.  I am still unhappy with the lack of consistent
results
with this drug for sedation.
 
As for methoxital, I agree with Marti - it works great and is very short
 
acting when used IV.
 
Enjoy the rest of the summer!
 
Mike Gerardi
 
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