ABSTRACT
BACKGROUND: The American Academy of Pediatrics and American Society of Anesthesiologists have published consensus-based fasting guidelines intended to reduce the risk of pulmonary aspiration. The purpose of our study was to compare the rate of adverse events in patients sedated with ketamine within 2 hours of oral contrast intake to those who were nil per os (NPO). METHODS: A retrospective cohort review of a database of children between July 2008 and May 2011. The rate of adverse events in children sedated with ketamine after intake of oral contrast for an abdominal computed tomography were compared with those sedated without taking oral contrast. RESULTS: One hundred and four patients sedated for a computed tomography scan; 22 patients were sedated within 2 hours of taking oral contrast, and 82 were NPO. The 2 groups were comparable with regard to gender, race, and American Society of Anesthesiologists status. The mean (SD) time between the second dose of oral contrast and induction of sedation was 58 (24) minutes. Vomiting occurred in 4 of 22 patients in the oral contrast group (18%; 95% confidence interval 2%-34%) and 1 of 82 patients in the NPO group (1%; 95% confidence interval, 0%, 4%; P < .001). There was no difference in oxygen desaturation between the groups (P = .6). CONCLUSIONS: Children who received oral contrast up to 58 minutes before ketamine sedation had a higher rate of vomiting than those who did not receive oral contrast. We did not identify cases of clinical aspiration, and the incidence of hypoxia between the 2 groups was not statistically significant.
Subject(s)
Conscious Sedation , Contrast Media/administration & dosage , Ketamine , Administration, Oral , Anesthetics, Dissociative/administration & dosage , Anesthetics, Dissociative/adverse effects , Child , Child, Preschool , Conscious Sedation/adverse effects , Conscious Sedation/methods , Female , Humans , Incidence , Infant , Infant, Newborn , Ketamine/administration & dosage , Ketamine/adverse effects , Male , Radiography, Abdominal/methods , Respiratory Aspiration/epidemiology , Respiratory Aspiration/etiology , Respiratory Aspiration/prevention & control , Retrospective Studies , Risk Assessment , Time Factors , Tomography, X-Ray Computed/methods , United States/epidemiology , Vomiting/epidemiology , Vomiting/etiologyABSTRACT
BACKGROUND AND OBJECTIVE: Intravenous pentobarbital has been used in the past to sedate pediatric patients in preparation for MRI; however, the drug has unpredictable sedation time. Dexmedetomidine, because of its short half-life, is gaining popularity for pediatric MRI sedation in settings where the use of propofol is restricted for nonanesthesiologists. The objective was to compare induction time, recovery time, total sedation time, sedation failure rate, and adverse outcomes of patients sedated with pentobarbital and dexmedetomidine in preparation for pediatric MRI. METHODS: We reviewed a sedation database that contains clinical data for all children undergoing MRI studies while sedated with pentobarbital or dexmedetomidine between May 15, 2008, and October 30, 2010. RESULTS: During the study period, 281 sedations were induced in preparation for MRI (160 with pentobarbital, and 121 with dexmedetomidine). The 2 groups were comparable with regard to age, weight, gender, and American Society of Anesthesiologists status. The dexmedetomidine group had a significantly shorter recovery time (39 ± 21 vs 49 ± 27 minutes [P = .002]) and total sedation time (107 ± 28 vs 157 ± 44 minutes [P = .0001]). Induction time was similar between the groups. The adverse event rate for the study population was 3%. CONCLUSIONS: Dexmedetomidine and pentobarbital can both be used successfully for MRI sedation in children. However, dexmedetomidine had a significantly shorter recovery time and total sedation time in our population.
