Sedation of pediatric patients: an anesthesiologist's perspective

Article Abstract:

With the increased use of computerized tomography (CT scan) and magnetic resonance imaging (MRI), the need to sedate children for radiologic imaging procedures has become increasingly common. Since anesthesiologists are rarely used for these procedures because of reimbursement limits, it is up to the radiologist to administer the drug and monitor the patient. In the June 1990 issue of Radiology, an article by Keeter et al. reports that current pediatric sedation practice does not meet the standards of the American Society of Anesthesiologists or the American Academy of Pediatrics. To avoid possible complications due to pediatric sedation, children with medical histories which could increase these complications need to be identified. High risk problems include abnormal airways, congenital heart disease, esophageal reflux, reactive airway disease, seizure disorders, the use of other medications, or increased intracranial pressure. Chloral hydrate is the most commonly used sedative and is minimally toxic, but is not as efficient a sedative as barbiturates. All patients receiving sedation (except for newborns) should also be administered oxygen to increase their oxygen reserve in case respiratory depression or an obstructed airway occurs. Since it is important to monitor for signs of these problems, the use of capnography (which helps monitor the amount of carbon dioxide in exhaled air) and oximetry (which estimates the oxygen saturation of blood) is recommended. However, both devises may result in complications. Besides monitoring for signs of insufficient respiration, body temperature should be monitored for extreme changes. A health care worker certified in cardiac life support, such as a pediatric nurse, should be responsible for monitoring the patient's ventilation once imaging is underway, so that the radiologist or technician can focus on the image screens. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Pediatric sedation

Article Abstract:

Radiologists who perform imaging techniques on children must be extra careful to avoid adverse reactions in the patient. Two situations which require extreme caution because of potential hazards are the use of contrast media and sedation. Sedation is usually needed when performing computed tomography (CT scans) and magnetic resonance imaging (MRI) on youngsters. Since the use of these imaging techniques is increasing, the frequency of sedation is also increasing. Proper protocol for sedation of children needs to be established. It is thought that most children who undergo these procedures are not being properly supervised by personnel trained in sedation and resuscitation. An article in the June 1990 issue of Radiology discusses this extensively; the authors assert that current practice of sedation in children does not meet the standards put forth by the American Academy of Pediatrics, and the number of complications resulting from pediatric sedation are underreported. The practice of pediatric sedation is a specialty in which few are knowledgeable, leaving much of the work to unqualified individuals. More information needs to be distributed to the medical community about this problem before acceptable levels of quality care can be established. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Efficacy of topical anesthesia in children

Article Abstract:

Anesthetics applied directly to a wound that contain lower concentrations of cocaine may be equally effective and cost less than anesthetics with higher concentrations of cocaine. It also appears that adrenaline is a necessary component in these local anesthetics. Researchers compared three anesthetic preparations including one containing tetracaine hydrochloride, adrenaline, and 11.8% cocaine (TAC1), one containing tetracaine hydrochloride, adrenaline, and 4% cocaine (TAC2), and one containing tetracaine hydrochloride, no adrenaline, and 4% cocaine (TAC3). TAC1 and TAC2 were equally effective in achieving complete anesthesia and both were more effective than TAC3 among the 158 children aged 3 to 18 years treated with these anesthetics before routine stitching. More children required two applications of TAC3 to achieve complete anesthesia than those treated with TAC1 or TAC2. The cost for a single application of TAC1 is $16.39, TAC2 is $8.67, and TAC3 is $8.41. These types of anesthetics do not require needle injections.

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