CC BY-NC-ND 4.0 · Indographics 2022; 01(01): 101-109
DOI: 10.1055/s-0042-1742577
Review Article

Sedation and General Anesthesia in Diagnostic Pediatric Imaging

Prakash Choudhary
1   Department of CT and MRI, Dr. Gulati Imaging Institute, Delhi, India
,
Neha Boski
1   Department of CT and MRI, Dr. Gulati Imaging Institute, Delhi, India
› Author Affiliations

Abstract

Objective In this article we will try and provide a comprehensive literature review on the use of sedation and general anesthesia (SAGA) in pediatric population for diagnostic studies and the salient differences in practices worldwide particularly with regards to the practice differences in developed versus developing countries.

Methods The key articles we obtained were primarily from Indian Journal of Anesthesia, Local NHS Trust protocols, PubMed, MEDLINE, NICE Evidence, UptoDate (Wolters Kluwer), and The Cochrane Library.

Results In the last two decades pediatric radiology has seen a huge increase in volume of procedures with a proportional increase in SAGA. The duration being dependent on the modality (for example, few minutes for computed tomography scan and up to an hour for magnetic resonance imaging particularly if there are multiple studies). SAGA has an extensive list of adverse effects that could be due to the underlying drug or due to wrong patient selection. The principles for safe use of the drugs remain the same just like any other medical or surgical procedure and include meticulous assessments of children and ruling out the contraindications, obtaining parental consent, deciding the drugs which can be given, ascertain the duration of procedure after communication with the radiologist, monitor closely before, during, and after the procedure, discharge, and after the discharge criteria are met. All the above criteria depend on the local guidelines and therefore vary from not only one country to the other but also from one institution to the other within the same country.

Conclusion As expected, the SAGA techniques, drugs, and personnel involved in delivering the care vary from country to country. However, the final and desired outcome remains the same that is to deliver safe care with acquisition of optimal images that serve the purpose of arriving at the correct diagnosis.



Publication History

Article published online:
19 September 2023

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  • References

  • 1 American Academy of Pediatrics. American Academy of Pediatric Dentistry, Cote CJ, Wilson S; Work Group on Sedation. “Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures: an update.” (“Local anesthetic systemic toxicity: current perspectives”) (“Complications associated with intravenous midazolam and ...”). Pediatrics 2006; 118: 2587-2602
  • 2 Green SM, Rothrock SG, Lynch EL. et al. Intramuscular ketamine for pediatric sedation in the emergency department: safety profile in 1,022 cases. Ann Emerg Med 1998; 31 (06) 688-697
  • 3 Malviya S, Voepel-Lewis T, Tait AR. Adverse events and risk factors associated with the sedation of children by nonanesthesiologists. Anesth Analg 1997; 85 (06) 1207-1213
  • 4 The Royal College of Radiologists. Safe sedation, analgesia and anaesthesia within the radiology department. September 2003. Accessed May 30, 2011 at: http://www.rcr.ac.uk/publications.aspx?PageID5310&
  • 5 Ruess L, O'Connor SC, Mikita CP, Creamer KM. Sedation for pediatric diagnostic imaging: use of pediatric and nursing resources as an alternative to a radiology department sedation team. Pediatr Radiol 2002; 32 (07) 505-510
  • 6 Malviya S, Voepel-Lewis T, Eldevik OP, Rockwell DT, Wong JH, Tait AR. Sedation and general anaesthesia in children undergoing MRI and CT: adverse events and outcomes. Br J Anaesth 2000; 84 (06) 743-748
  • 7 Committee on Drugs, Section on Anesthesiology, American Academy of Pediatrics. Guidelines for the elective use of conscious sedation, deep sedation, and general anesthesia in pediatric patients. Pediatrics 1985; 76: 317-321
  • 8 Cravero JP, Blike GT. Review of pediatric sedation. Anesth Analg 2004; 99 (05) 1355-1364
  • 9 Levati A, Paccagnella F, Pietrini D. et al; SIAARTI. SIAARTI-SARNePI Guidelines for sedation in pediatric neuroradiology. Minerva Anestesiol 2004; 70 (10) 675-697
  • 10 Green SM, Yealy DM. Procedural sedation goes Utstein: the Quebec guidelines. Ann Emerg Med 2009; 53 (04) 436-438
  • 11 Gozal D, Mason KP. Pediatric sedation: a global challenge. Int J Pediatr 2010; 2010: 701257
  • 12 Coté CJ. “Conscious sedation”: time for this oxymoron to go away!. J Pediatr 2001; 139 (01) 15-17
  • 13 doh.gov.uk. [homepage on the internet]. London, UK: Department of Health; 2003. . Available at: http://www.advisorybodies.doh.gov.uk/sdac/conscious_sedationdec03
  • 14 Meyer S, Grundmann U, Gottschling S, Kleinschmidt S, Gortner L. Sedation and analgesia for brief diagnostic and therapeutic procedures in children. Eur J Pediatr 2007; 166 (04) 291-302
  • 15 Coté CJ, Karl HW, Notterman DA, Weinberg JA, McCloskey C. Adverse sedation events in pediatrics: analysis of medications used for sedation. Pediatrics 2000; 106 (04) 633-644
  • 16 Coté CJ, Notterman DA, Karl HW, Weinberg JA, McCloskey C. Adverse sedation events in pediatrics: a critical incident analysis of contributing factors. Pediatrics 2000; 105 (4 Pt 1): 805-814
  • 17 Cravero JP, Blike GT, Beach M. et al; Pediatric Sedation Research Consortium. Incidence and nature of adverse events during pediatric sedation/anesthesia for procedures outside the operating room: report from the Pediatric Sedation Research Consortium. Pediatrics 2006; 118 (03) 1087-1096
  • 18 National Institute for Health and Clinical Excellence. NICE clinical guideline 112. Sedation in children and young people. December 2010. Accessed May 30, 2011 at: http://www.nice.org.uk/nicemedia/live/13296/52130/52130.pdf
  • 19 Arlachov Y, Ganatra RH. Sedation/anaesthesia in paediatric radiology. Br J Radiol 2012; 85 (1019): e1018-e1031
  • 20 Gooden CK. Anesthesia for magnetic resonance imaging. Curr Opin Anaesthesiol 2004; 17 (04) 339-342
  • 21 Scottish Intercollegiate Guidelines Network. Safe sedation of children undergoing diagnostic and therapeutic procedures. A National Clinical Guideline. May 2004. Accessed June 7, 2011 at: http://www.blackwellpublishing.com/medicine/bmj/nnf5/pdfs/guidelines/Scottish_guideline.pdf
  • 22 Usher A, Kearney R. Anesthesia for magnetic resonance imaging in children: a survey of Canadian pediatric centres. Can J Anaesth 2003; 50 (04) 425
  • 23 Usher AG, Kearney RA, Tsui BCH. Propofol total intravenous anesthesia for MRI in children. Paediatr Anaesth 2005; 15 (01) 23-28
  • 24 Sury MR, Harker H, Thomas ML. Sevoflurane sedation in infants undergoing MRI: a preliminary report. Paediatr Anaesth 2005; 15 (01) 16-22
  • 25 DeSanctis Briggs V. Magnetic Resonance Imaging under sedation in newborns and infants: a study of 640 cases using sevoflurane. Paediatr Anaesth 2005; 15: 9-15
  • 26 Bhat R, Mitragotri MV. A child with difficult airway for magnetic resonance imaging: is dexmedetomidine useful?. Indian J Anaesth 2015; 59 (10) 687-688
  • 27 Buck ML. Chloral hydrate use during infancy. Neonatal Pharmacol Q 1992; 1: 31-37
  • 28 Sury MRJ. FRCA paediatric sedation. Contin Educ Anaesth Crit Care Pain 2004; 4 (04) 118-122
  • 29 Buck ML. The use of chloral hydrate in infants and children. Pediatric Pharmacotherapy. A Monthly Newsletter for Health Care Professionals from the University of Virginia Children's Hospital. September 2005;11(9):4. Available at: http://www.medicine.virginia.edu/clinical/departments/pediatrics/education/pharm-news/2001-2005/200509.pdf
  • 30 Kaplan RF, Yaster M, Srafford MA, Cote CJ. Paediatric sedation for diagnostic and therapeutic procedures outside the operating room. In: Cote CJ, Todres ID, Ryan JF, Goudsouzian NG. eds. A Practice of Anaesthesia for Infants and Children. Philadelphia, PA: WB Saunders Company; 2001: 584-609
  • 31 Malviya S, Voepel-Lewis T, Ludomirsky A, Marshall J, Tait AR. Can we improve the assessment of discharge readiness?: A comparative study of observational and objective measures of depth of sedation in children. Anesthesiology 2004; 100 (02) 218-224
  • 32 Pitetti R, Davis PJ, Redlinger R, White J, Wiener E, Calhoun KH. Effect on hospital-wide sedation practices after implementation of the 2001 JCAHO procedural sedation and analgesia guidelines. Arch Pediatr Adolesc Med 2006; 160 (02) 211-216