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Options and Considerations for Procedural Sedation in Pediatric Imaging

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Abstract

As pediatric imaging capabilities have increased in scope, so have the complexities of providing procedural sedation in this environment. While efforts by many organizations have dramatically increased the safety of pediatric procedural sedation in general, radiology sedation creates several special challenges for the sedation provider. These challenges require implementation of additional safeguards to promote safety during sedation while maintaining effective and efficient care. Multiple agent options are available, and decisions regarding which agent(s) to use should be determined by both patient needs (i.e., developmental capacities, underlying health status, and previous experiences) and procedural needs (i.e., duration, need for immobility, and invasiveness). Increasingly, combinations of agents to either achieve the conditions required or mitigate/counterbalance adverse effects of single agents are being utilized with success. To continue to provide effective imaging sedation, it is incumbent on sedation providers to maintain familiarity with continuing evolutions within radiology environments, as well as comfort and competence with multiple sedation agents/regimens. This review discusses the challenges associated with radiology sedation and outlines various available agent options and combinations, with the intent of facilitating appropriate matching of agent(s) with patient and procedural needs.

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References

  1. Glatz AC, Zhu X, Gillespie MJ, Hanna BD, Rome JJ. Use of angiographic CT imaging in the cardiac catheterization laboratory for congenital heart disease. JACC Cardiovasc Imaging. 2010;3:1149–57.

    Article  PubMed  Google Scholar 

  2. Driessen MMP, Breur JMPJ, Budde RPJ, van Oorschot JWM, van Kimmenade RRJ, Sieswerda GT, Meijboom FJ, Leiner T. Advances in cardiac magnetic resonance imaging of congenital heart disease. Pediatr Radiol. 2015;45:5–19.

    Article  PubMed  Google Scholar 

  3. Lord DJE. The practice of pediatric interventional radiology. Tech Vasc Interventional Rad. 2011;14:2–7.

    Article  Google Scholar 

  4. Cravero JP, Beach ML, Blike GT, Gallagher SM, Hertzog JH, the 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;118:1087–96.

    Article  PubMed  Google Scholar 

  5. Cameron JA, Bond MJ, Pointer SC. Reducing the anxiety of children undergoing surgery: parental presence during anaesthetic induction. J Paediatr Child Health. 1996;32:51–6.

    Article  CAS  PubMed  Google Scholar 

  6. Krauss B, Green SM. Sedation and analgesia for procedures in children. NEJM. 2000;342:938–45.

    Article  CAS  PubMed  Google Scholar 

  7. American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists. Practice guidelines for sedation and analgesia by non-anesthesiologists: an update. Anesthesiology. 2002;96:1004–17.

  8. 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. Pediatrics. 2006;118:2587–602.

    Article  Google Scholar 

  9. Kaufman RA. Technical aspects of abdominal CT in infants and children. Am J Roentgen. 1989;153:549–54.

    Article  CAS  Google Scholar 

  10. Mahmoud M, McAuliffe J, Kim HY, Mishra P, Salisbury S, Schnell B, Hirsch P, Arbabi S, Donnelly L. Oral contrast for abdominal computed tomography in children: the effects on gastric fluid volume. Anesth Analg. 2010;111:1252–8.

    Article  PubMed  Google Scholar 

  11. ACR-SIR Practice parameter for sedation/analgesia. 2014. http://www.acr.org/~/media/F194CBB800AB43048B997A75938AB482.pdf. Accessed 30 Mar 2015.

  12. Langhan ML, Mallory M, Hertzog J, Lowrie L, Cravero J, for the Pediatric Sedation Research Consortium. Physiologic monitoring practices during pediatric procedural sedation: a report from the Pediatric Sedation Research Consortium. Arch Pediatr Adolesc Med. 2012;166:990–8.

    Article  PubMed  Google Scholar 

  13. Joint Commission on Accreditation of Healthcare Organizations. Comprehensive accreditation manual for hospitals. Oakbrook Terrace: Joint Commission on Accreditation of Healthcare Organizations; 2005.

    Google Scholar 

  14. Hoffman GM, Nowakowski R, Troshynski TJ, Bereks RJ, Weisman SJ. Risk reduction in procedural sedation by application of an American Academy of Pediatrics/American Society of Anesthesiologists process model. Pediatrics. 2002;109:236–43.

    Article  PubMed  Google Scholar 

  15. 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 Adolessc Med. 2006;160:211–6.

    Article  Google Scholar 

  16. Samsoon GL, Young JR. Difficult tracheal intubation: a retrospective study. Anaesthesia. 1987;42:487–90.

    Article  CAS  PubMed  Google Scholar 

  17. Golan A, Marco R, Raz H, Shany E. Imaging in the newborn: infant immobilizer obviates the need for anesthesia. IMAJ. 2011;13:663–5.

    PubMed  Google Scholar 

  18. Etzel-Hardman, Kapsin K, Jones S, Churilla H. Sedation reduction in a pediatric radiology department. J Healthc Qual 2009;31:34–39.

  19. Kulkarni S, Johnson PCD, Kettles S, Kasthuri RS. Music during interventional radiological procedures, effect on sedation, pain and anxiety: a randomized controlled trial. Br J Radiol. 2012;85:1059–63.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  20. Evans RG, Crawford MW, Noseworthy MD, Yoo SJ. Effect of increasing depth of propofol anesthesia on upper airway configuration in children. Anesthesiology. 2003;99:596–602.

    Article  CAS  PubMed  Google Scholar 

  21. Mahmoud M, Radhakrishman R, Gunter J, Sadhasivam S, Schapiro A, McAuliffe J, Kurth D, Wang Y, Nick TG, Donnelly LF. Effect of increasing depth of dexmedetomidine anesthesia on upper airway morphology in children. Pediatr Anesth. 2010;20:506–15.

    Article  Google Scholar 

  22. Grunwell JR, McCracken C, Fortenberry J, Stockwell J, Kamat P. Risk factors leading to failed procedural sedation in children outside the operating room. Pediatr Emerg Care. 2014;30:381–7.

    Article  PubMed  Google Scholar 

  23. Scherrer PD, Mallory MM, Cravero JP, Lowrie L, Hertzog JH, Berkenbosch JW, for the Pediatric Sedation Research Consortium. The impact of obesity on procedural sedation-related outcomes: results from the Pediatric Sedation Research Consortium. Paediatr Anaesth. 2015;25:689–97.

    Article  PubMed  Google Scholar 

  24. Kang J, Vann WF, Lee JY, Anderson JA. The safety of sedation for overweight/obese children in the dental setting. Pediatr Dent. 2012;34:392–6.

    PubMed  Google Scholar 

  25. Dalal PG, Murray D, Cox T, McAllister J, Snider R. Sedation and anesthesia protocols used for magnetic resonance imaging studies in infants: provider and pharmacologic considerations. Anesth Analg. 2006;1–3:863–8.

    Article  CAS  Google Scholar 

  26. Ehrnebo M. Pharmacokinetics and distribution properties of pentobarbital in humans following oral and intravenous administration. J Pharm Sci. 1974;63:1114–8.

    Article  CAS  PubMed  Google Scholar 

  27. Mason KP, Zurakowski D, Connor L, Karian VE, Fontaine PJ, Sanborn PA, Burrows PE. Infant sedation for MR imaging and CT: oral vs intravenous pentobarbital. Radiology. 2004;233:723–8.

    Article  PubMed  Google Scholar 

  28. Malviya S, Voepel-Lewis T, Tait AR, Reynolds PI, Gujar SK, Gebarski SS, Eldevik OP. Pentobarbital vs chloral hydrate for sedation of children undergoing MRI: efficacy and recovery characteristics. Pediatr Anesth. 2004;14:589–95.

    Article  Google Scholar 

  29. Mallory MD, Baxter AL, Kost SI, the Pediatric Sedation Research Consortium. Propofol vs pentobarbital for sedation of children undergoing magnetic resonance imaging: results of the Pediatric Sedation Research Consortium. Pediatr Anesth. 2009;19:601–11.

    Article  Google Scholar 

  30. Strain JD, Campbell JB, Harvey LA, et al. IV nembutal: safe sedation for children undergoing CT. Am J Roentgen. 1988;151:975–9.

    Article  CAS  Google Scholar 

  31. Chun TH, Amanullah S, Karishma-Bahl J, Machan JT, Andrada ER, Lewander WJ. Comparison of methohexital and pentobarbital as sedative agents for pediatric emergency department patients for computed tomography. Pediatr Emerg Care. 2009;25:648–50.

    Article  PubMed  Google Scholar 

  32. Mason KP, Sanborn PA, Zurakowski D, Karian VE, Connor L, Fontaine PJ, Burrows PE. Superiority of pentobarbital versus chloral hydrate for sedation in infants during imaging. Radiology. 2004;230:1537–42.

    Article  Google Scholar 

  33. Warden CN, Bernard PK, Kimball TR. The efficacy and safety of oral pentobarbital sedation in pediatric echocardiography. J Am Soc Echocardiogr. 2010;23:33–7.

    Article  PubMed  Google Scholar 

  34. Mason KP, Zurakowski D, Karian VE, Connor L, Fontaine PJ, Burrows PE. Sedatives used in pediatric imaging: comparison of IV pentobarbital with IV pentobarbital with midazolam added. Am J Roentgen. 2001;177:427–30.

    Article  CAS  Google Scholar 

  35. Rubin JT, Towbin RB, Bartko M, Baskin KM, Cahill AM, Kaye RD. Oral and intravenous caffeine for treatment of children with post-sedation paradoxical hyperactivity. Pediatr Radiol. 2004;34:980–4.

    Article  PubMed  Google Scholar 

  36. Mason KP, Prescilla R, Fontaine PJ, Zurakowski D. Pediatric CT sedation: comparison of dexmedetomidine and pentobarbital. Am J Roentgenol. 2011;196:W194–8.

    Article  Google Scholar 

  37. Manuli MA, Davies L. Rectal methohexital for sedation of children during imaging procedures. Am J Roentgenol. 1993;160:577–80.

    Article  CAS  Google Scholar 

  38. Pomeranz E, Chudnofsky CR, Deegan TJ, Lozon MM, Mitchiner JC, Weber JE. Rectal methohexital sedation for computed tomography imaging of stable emergency department patients. Pediatrics. 2000;105:1110–4.

    Article  CAS  PubMed  Google Scholar 

  39. Sedik S. Use of intravenous methohexital as a sedative in pediatric emergency departments. Arch Pediatr Adolesc Med. 2001;155:665–8.

    Article  CAS  PubMed  Google Scholar 

  40. Austin T, Vilke GM, Nyheim E, Kelly D, Chan TC. Safety and effectiveness of methohexital for procedural sedation in the emergency department. J Emerg Med. 2003;24:315–8.

    Article  PubMed  Google Scholar 

  41. Liu LMP, Gaudreault P, Friedman PA, Goudsouzian NG. Methohexital plasma concentrations in children following rectal administration. Anesthesiology. 1985;62:567–70.

    Article  CAS  PubMed  Google Scholar 

  42. Rockoff MA, Goudsouzian NG. Seizures induced by methohexital. Anesthesiology. 1981;54:333–5.

    Article  CAS  PubMed  Google Scholar 

  43. Marx CM, Stein J, Tyler MK, Nieder ML, Shurin SB, Blumer JL. Ketamine–midazolam versus meperidine–midazolam for painful procedures in pediatric oncology patients. J Clin Oncol. 1997;15:94–102.

    CAS  PubMed  Google Scholar 

  44. Kennedy RM, Porter FL, Miller J, Jaffe DM. Comparison of fentanyl/midazolam with ketamine/midazolam for pediatric orthopedic emergencies. Pediatrics. 1998;102:956–63.

    Article  CAS  PubMed  Google Scholar 

  45. Litman RS. Conscious sedation with remifentanil and midazolam during brief painful procedures in children. Arch Pediatr Adolesc Med. 1999;153:1085–8.

    Article  CAS  PubMed  Google Scholar 

  46. Sherwin TS, Green SM, Khan A, Chapman DS, Dannenberg B. Does adjunctive midazolam reduce recovery agitation after ketamine sedation for pediatric procedures? A randomized, double-blind, placebo-controlled trial. Ann Emerg Med. 2000;35:229–38.

    Article  CAS  PubMed  Google Scholar 

  47. Wathen JE, Roback MG, Mackenzie T, Bothner JP. Does midazolam alter the clinical effects of intravenous ketamine sedation in children? A double-blind, randomized, controlled, emergency department trial. Ann Emerg Med. 2000;36:579–88.

    Article  CAS  PubMed  Google Scholar 

  48. Klein EJ, Diekema DS, Paris CA, Quan L, Cohen M, Seidel KD. A randomized, clinical trial of oral midazolam plus placebo versus oral midazolam plus oral transmucosal fentanyl for sedation during laceration repair. Pediatrics. 2002;109:894–7.

    Article  PubMed  Google Scholar 

  49. Ljungman G, Kreuger A, Andreasson S, Gorgh T, Sorensen S. Midazolam nasal spray reduces procedural anxiety in children. Pediatrics. 2000;105:73–8.

    Article  CAS  PubMed  Google Scholar 

  50. Lane RD, Schunk JE. Atomized intranasal midazolam use for minor procedures in the pediatric emergency department. Pediatr Emerg Care. 2008;24:300–3.

    Article  PubMed  Google Scholar 

  51. Ljung BAS. Comparison of midazolam nasal spray to nasal drops for the sedation of children. J Nucl Med Technol. 1996;24:32–4.

    CAS  Google Scholar 

  52. Chiaretti A, Barone G, Rigante D, Ruggiero A, Pierri F, Barbi E, Barone G, Riccardi R. Intranasal lidocaine and midazolam for procedural sedation in children. Arch Dis Child. 2011;96:160–3.

    Article  PubMed  Google Scholar 

  53. Massanari M, Novitsky J, Reinstein LJ. Paradoxical reactions in children associated with midazolam use during endoscopy. Clin Pediatr. 1997;36:681–4.

    Article  CAS  Google Scholar 

  54. Hunkeler W, Mohler H, Pieri L, Polc P, Bonetti EP, Cumin R, Schaffner R, Haefely W. Selective antagonists of benzodiazepines. Nature. 1981;290:514–6.

    Article  CAS  PubMed  Google Scholar 

  55. Shannon M, Albers G, Burkhart K, Liebelt E, Kelley M, McCubbin MM, Hoffman J, Massarella J, the Flumazenil Pediatric Study Group. Safety and efficacy of flumazenil in the reversal of benzodiazepine-induced conscious sedation. J Pediatr. 1997;131:582–6.

    Article  CAS  PubMed  Google Scholar 

  56. Peters JM, Tolia V, Simpson P, Aravind MA, Kauffman RE. Flumazenil in children after esophagogastroduodenoscopy. Am J Gastroenterol. 1999;94:1857–61.

    Article  CAS  PubMed  Google Scholar 

  57. Ronchera-Oms CL, Casillas C, Marti-Bonmati L, et al. Oral chloral hydrate provides effective and safe sedation in paediatric magnetic resonance imaging. J Clin Pharm Therap. 1994;19:239–43.

    Article  CAS  Google Scholar 

  58. Bracken J, Heaslip I, Ryan S. Chloral hydrate sedation in radiology: retrospective audit of reduced dose. Pediatr Radiol. 2012;42:349–54.

    Article  PubMed  Google Scholar 

  59. Malviya S, Voepel-Lewis T, Tait AR, Merkel S, Tremper K, Naughton N. Depth of sedation in children undergoing computed tomography: validity and reliability of the University of Michigan Sedation Scale (UMSS). Br J Anaesth. 2002;88:241–5.

    Article  CAS  PubMed  Google Scholar 

  60. Fallah R, Nakhaei MH, Behdad S, Moghaddam RN, Shamszadeh A. Oral chloral hydrate and intranasal midazolam for sedation during computerized tomography. Indian Pediatr. 2013;50:233–5.

    Article  PubMed  Google Scholar 

  61. Treluyer JM, Andre C, Carp PF, Chalumeau M, Tonelier S, Cuq C, Kalifa G, Pons G, Adamsbaum C. Sedation in children undergoing CT scan or MRI: effect of time-course and tolerance of rectal chloral hydrate. Fundam Clin Pharmacol. 2004;18:347–50.

    Article  CAS  PubMed  Google Scholar 

  62. Lipschitz M, Marino BL, Sanders ST. Chloral hydrate side effects in young children: causes and management. Heart Lung. 1993;22:408–14.

    Google Scholar 

  63. Avlonitou E, Balatsouras DG, Margaritis E, Giannakopoulos P, Douniadakis D, Tsakanikos M. Use of chloral hydrate as a sedative for auditory brainstem response testing in a pediatric population. Int J Pediatr Otorhinolaryngol. 2011;75:760–3.

    Article  PubMed  Google Scholar 

  64. Jastak JT, Pallasch T. Death after chloral hydrate sedation: report of a case. J Am Dent Assoc. 1988;116:345–8.

    Article  CAS  PubMed  Google Scholar 

  65. Cote CJ, Karl HW, Notterman DA, Weinberg JA, McCloskey C. Adverse sedation events in pediatrics: analysis of medications used for sedation. Pediatrics. 2000;106:633–44.

    Article  CAS  PubMed  Google Scholar 

  66. Coursin DB, Coursin DB, Maccioli GA. Dexmedetomidine: pharmacology, metabolism, and nutrition. Curr Opin Crit Care. 2001;7:221–6.

    Article  CAS  PubMed  Google Scholar 

  67. Tobias JD, Berkenbosch JW. Initial experience with dexmedetomidine in paediatric-aged patients. Paediatr Anaesth. 2002;17:171–5.

    Article  Google Scholar 

  68. Mason KP, Lubisch NB, Robinson F, Roskos R. Intramuscular dexmedetomidine sedation for pediatric MRI and CT. Am J Roentgenol. 2011;197:720–5.

    Article  Google Scholar 

  69. Berkenbosch JW, Wankum P, Tobias JD. A prospective evaluation of dexmedetomidine for non-invasive procedural sedation in children. Pediatr Crit Care Med. 2005;6:435–9.

    Article  PubMed  Google Scholar 

  70. Koroglu A, Teksan H, Sagir O, Yucel A, Toprak HI, Ersoy OM. A comparison of the sedative, hemodynamic and respiratory effects of dexmedetomidine and propofol in children undergoing magnetic resonance imaging examination. Anesth Analg. 2006;103:63–7.

    Article  CAS  PubMed  Google Scholar 

  71. Mason KP, Zurakowski D, Zgleszewski SE, Robson CD, Carrier M, Hickey PR, Dinardo JA. High dose dexmedetomidine as the sole sedative for pediatric MRI. Paediatr Anaesth. 2008;18:403–11.

    Article  PubMed  Google Scholar 

  72. Lubisch N, Roskos R, Berkenbosch JW. Dexmedetomidine for procedural sedation in children with autism spectrum disorders and other neurobehavioral disorders. Pediatr Neurol. 2009;41:88–94.

    Article  PubMed  Google Scholar 

  73. Berkenbosch JW, Yakkanti RR, Farrell DL, Gilliland FL, Hignite JL, Sullivan JE. Bolus vs bolus + infusion use of dexmedetomidine sedation for MRI. Crit Care Med. 2015;42:A1519.

    Article  Google Scholar 

  74. Anttila M, Penttila J, Helminen A, Vuorilehto L, Scheinin H. Bioavailability of dexmedetomidine after extravascular doses in healthy subjects. Br J Clin Pharmacol. 2003;56:691–3.

    Article  PubMed Central  PubMed  Google Scholar 

  75. Sakurai Y, Obata T, Odaka A, Terui K, Tamura M, Miyao H. Buccal administration of dexmedetomidine as a preanesthetic in children. J Anesth. 2010;24:49–53.

    Article  PubMed  Google Scholar 

  76. Cimen ZS, Hanci A, Sivrikaya GU, Kilinc LT, Erol MK. Comparison of buccal and nasal dexmedetomidine premedication for pediatric patients. Paediatr Anaesth. 2013;23:134–8.

    Article  PubMed  Google Scholar 

  77. Zub D, Berkenbosch JW, Tobias JD. Preliminary experience with oral dexmedetomidine for procedural and anesthetic premedication. Pediatr Anesth. 2005;15:932–8.

    Article  Google Scholar 

  78. Ilirola T, Vilo S, Manner T, Aantaa R, Lahtinen M, Scheinin M, Olkkola KT. Bioavailability of dexmedetomidine after intranasal administration. Eur J Clin Pharmacol. 2011;67:825–31.

    Article  CAS  Google Scholar 

  79. Yeun VM, Hui TW, Yao TJ, Chan L, Wong GL, Hasan S, Shariffuddin II. A randomized comparison of two intranasal dexmedetomidine doses for premedication in children. Anaesthesia. 2012;67:1210–6.

    Article  CAS  Google Scholar 

  80. Ahmed SS, Unland T, Slaven JE, Nitu ME. High dose dexmedetomidine: effective as a sole agent for children undergoing MRI. Int J Pediatr. 2015;2015:397372.

    PubMed Central  PubMed  Google Scholar 

  81. Mason KP, Zgleszewski SE, Prescilla R, Fontaine PJ, Zurakowski D. Hemodynamic effects of dexmedetomidine sedation for CT imaging studies. Paediatr Anaesth. 2008;18:393–402.

    Article  PubMed  Google Scholar 

  82. Berkenbosch JW, Tobias JD. Development of bradycardia during sedation with dexmedetomidine in a patient concurrently receiving digoxin. Pediatr Crit Care Med. 2003;4(2):203–5.

    Article  PubMed  Google Scholar 

  83. Tobias JD, Gupta P, Naguib A, Yates AR. Dexmedetomidine: applications for the pediatric patient with congenital heart disease. Pediatr Cardiol. 2011;32:1075–87.

    Article  PubMed  Google Scholar 

  84. Mason KP, O’Mahony E, Zurakowski D, Libenson MH. Effects of dexmedetomidine sedation on the EEG in children. Pediatr Anesth. 2009;19:1175–83.

    Article  Google Scholar 

  85. Aksu R, Kumandas S, Akin A, Bicer C, Gumus H, Guler G, Per H, Bayram A, Boyaci A. The comparison of the effects of dexmedetomidine and midazolam sedation on electroencephalography in pediatric patients with febrile convulsion. Pediatr Anaesth. 2011;21:373–8.

    Article  Google Scholar 

  86. Tosun Z, Akin A, Guler G, Esmaoglu A, Boyaci A. Dexmedetomidine-ketamine and propofol-ketamine combinations for anesthesia in spontaneously breathing pediatric patients undergoing cardiac catheterization. J Cardiothorac Vasc Anesth. 2006;20(4):515–9.

    Article  CAS  PubMed  Google Scholar 

  87. Mester R, Easley RB, Brady KM, Chilson K, Tobias JD. Monitored anesthesia care with a combination of ketamine and dexmedetomidine during cardiac catheterization. Am J Ther. 2008;15:24–30.

    Article  PubMed  Google Scholar 

  88. Berkenbosch JW, Farrell D, Gilliland F, Hignite J, Sullivan JE. Impact of ketamine coadministration on sedation-related outcomes during dexmedetomidine sedation for MRI. Crit Care Med. 2015;42:A1377.

    Article  Google Scholar 

  89. Kiensta AJ, Ward MA, Sasan F, Hunter J, Morriss MC, Macias CG. Etomidate versus pentobarbital for sedation of children for head and neck CT imaging. Pediatr Emerg Care. 2004;20:499–506.

    Article  Google Scholar 

  90. Baxter AL, Mallory MD, Spandorfer PR, Sharma S, Freilich SH, Cravero J. Etomidate versus pentobarbital for computed tomography scans: report from the Pediatric Sedation Research Consortium. Pediatr Emerg Care. 2007;23:690–5.

    Article  PubMed  Google Scholar 

  91. Di Liddo L, D’Angelo A, Nguyen B, Bailey B, Amre D, Stanciu C. Etomidate versus midazolam for procedural sedation in pediatric outpatients: a randomized clinical trial. Ann Emerg Med. 2006;48:433–40.

    Article  PubMed  Google Scholar 

  92. Lee-Jayaram JJ, Green A, Siembieda J, Gracely EJ, Mull CC, Quintana E, Adirim T. Ketamine/midazolam versus etomidate/fentanyl: procedural sedation for pediatric orthopedic fractures. Pediatr Emerg Care. 2010;26:408–12.

    Article  PubMed  Google Scholar 

  93. Babi FE, Oakley E, Seaman C, Barnett P, Sharwood LN. High-concentration nitrous oxide for procedural sedation in children: adverse events and depth of sedation. Pediatrics. 2008;121:e528–32.

    Article  Google Scholar 

  94. Zier JL, Meixia MS. Safety of high-concentration nitrous oxide by nasal mask for pediatric procedural sedation: experience with 7802 cases. Ped Emerg Med. 2011;27:1107–12.

    Google Scholar 

  95. Zier JL, Kvam KA, Kurachek SC, Finkelstein M. Sedation with nitrous oxide compared to no sedation during catheterization for urologic imaging in children. Pediatr Radiol. 2007;37:678–84.

    Article  PubMed  Google Scholar 

  96. Keidan I, Zaslansky R, Weinberg M, Ben-Shlush A, Jacobson JM, Augarten A, Mor Y. Sedation during voiding cystourethrography: comparison of the efficacy and safety of using oral midazolam and continuous flow nitrous oxide. J Urol. 2005;174:1598–601.

    Article  PubMed  Google Scholar 

  97. Satoh M, Minami M. Molecular pharmacology of the opioid receptors. Pharmacol Ther. 1995;68:343–64.

    Article  CAS  PubMed  Google Scholar 

  98. Dun MJ, Mitchell R, Souza CD, Drummond G. evaluation of propofol and remifentanilfor intravenous sedation for reducing shoulder dislocations. Emerg Med. 2006;23:57–8.

    Article  Google Scholar 

  99. Berkenbosch JW, Graff GR, Stark JM, Ner Z, Tobias JD. Use of a remifentanil–propofol mixture for pediatric flexible fiberoptic bronchoscopy sedation. Paediatr Aneasth. 2004;14:856–60.

    Article  Google Scholar 

  100. Pedersen NA, Jensen AG, Kilmore L, Olsen KS. Propofol–remifentanil or sevoflurane for children undergoing magnetic resonance imaging? A randomized study. Acta Anaesthesiol Scand. 2013;57:988–95.

    Article  CAS  PubMed  Google Scholar 

  101. Chamberlain JM, Klein BL. A comprehensive review of naloxone for emergency physician. Am J Emerg Med. 1994;12:650–60.

    Article  CAS  PubMed  Google Scholar 

  102. Barsan WG, Seger D, Danzl DF, Ling LJ, Bartlett R, Buncher R, Bryan C. Duration of antagonistic effects of nalmefene and naloxone in opiate-induced sedation for emergency department procedures. Am J Emerg Med. 1989;7:155–61.

    Article  CAS  PubMed  Google Scholar 

  103. Chumpa A, Kaplan RL, Burns MM, Shannon MW. Nalmefene for elective reversal of procedural sedation in children. Am J Emerg Med. 2001;19:545–8.

    Article  CAS  PubMed  Google Scholar 

  104. White PF, Way WLW, Trevor AJ. Ketamine—its pharmacology and therapeutic uses. Anesthesiology. 1982;56:119–36.

    Article  CAS  PubMed  Google Scholar 

  105. Green SM, Krauss B. Clinical practice guideline for emergency department ketamine dissociative sedation in children. Ann Emerg Med. 2004;44:460–71.

    Article  PubMed  Google Scholar 

  106. Green SM, Rothrock SG, Lynch EL, Ho M, Harris T, Hestdalen R, Hopkins GA, Garrett W, Westcott K. Intramuscular ketamine for pediatric sedation in the emergency department: safety profile in 1022 cases. Ann Emerg Med. 1998;31:688–97.

    Article  CAS  PubMed  Google Scholar 

  107. Ramaswamy P, Babi FE, Deasy C, Sharwood LN. Pediatric procedural sedation with ketamine: time to discharge after intramuscular versus intravenous administration. Acad Emerg Med. 2009;16:101–7.

    Article  PubMed  Google Scholar 

  108. Green SM, Roback MG, Krauss B, Brown L, McGlone RG, Agrawal D, McKee M, Weiss M, Pitetti RD, Hostetler MA, Wathen JE, Treston G, Garcia Pena BM, Gerber AC, Losek JD, Emergency Department Ketamine Meta-Analysis Study Group. Predictors of emesis and recovery agitation with emergency department ketamine sedation: an individual-patient data meta-analysis of 8282 children. Ann Emerg Med. 2009;54:171–80.

    Article  PubMed  Google Scholar 

  109. Langan ML, Chen L, Marshall C, Santucci KA. Detection of hypoventilation by capnography and its association with hypoxia in children undergoing sedation with ketamine. Ped Emerg Med. 2011;27:394–7.

    Google Scholar 

  110. Alletag MJ, Auerbach MA, Baum CR. Ketamine, propofol, and ketofol use for pediatric sedation. Pediatr Emerg Care. 2012;28:1391–5.

    Article  PubMed  Google Scholar 

  111. Aouad MT, Moussa AR, Dagher CM, Muwakkit SA, Jabbour-Khoury SI, Zbeidy RA, Abboud MR, Kanazi GE. Addition of ketamine to propofol for initiation of procedural anesthesia in children reduces propofol consumption and preserves hemodynamic stability. Acta Anaesthesiol Scand. 2008;52:561–5.

    Article  CAS  PubMed  Google Scholar 

  112. Bryson HM, Fulton BR, Faulds D. Propofol: an update of its use in anaesthesia and conscious sedation. Drugs. 1995;50:513–59.

    Article  CAS  PubMed  Google Scholar 

  113. Reeves ST, Havidich JE, Tobin DP. Conscious sedation of children with propofol is anything but conscious. Pediatrics. 2004;114:e74–6.

    Article  PubMed  Google Scholar 

  114. Cravero JP, Beach M, Blike GT, Gallagher SM, Hertzog JH, Pediatric Sedation Research Consortium. The incidence and nature of adverse events during pediatric sedation/anesthesia with propofol for procedures outside the operating room: a report from the Pediatric Sedation Research Consortium. Anesth Analg. 2009;108:795–804.

    Article  CAS  PubMed  Google Scholar 

  115. Mallory MD, Baxter AL, Yanosky DJ, Cravero JP, Pediatric Sedation Research Consortium. Emergency physician-administered propofol sedation: a report on 25,433 sedations from the Pediatric Sedation Research Consortium. Ann Emerg Med. 2011;57:462–8.

    Article  PubMed  Google Scholar 

  116. Srinivasan M, Turmelle M, DePalma LM, Mao J, Carlson D. Procedural sedation for diagnostic imaging by pediatric hospitalists using propofol: analysis of the nature, frequency, and predictors of adverse events and interventions. J Pediatr. 2012;160:801–6.

    Article  PubMed  Google Scholar 

  117. Barbi E, Petaros P, Badina L, Pahor T, Guiseppin I, Biasotto E, Martelossi S, DiLeo G, Sarti A, Ventura A. Deep sedation with propofol for upper gastrointestinal endoscopy in children, administered by specially trained pediatricians: a prospective case series with emphasis on side effects. Endoscopy. 2006;38:368–75.

    Article  CAS  PubMed  Google Scholar 

  118. Murphy A, Campbell DE, Baines D, Mehr S. Allergic reactions to propofol in egg-allergic children. Anesth Analg. 2011;113:140–4.

    Article  CAS  PubMed  Google Scholar 

  119. Molina-Infante J, Arias A, Vara-Brenes D, Prados-Manzano R, Gonzalez-Cervera J, Alvarado-Arenas M, Lucendo AJ. Propofol administration is safe in adult eosinophilic esophagitis patients sensitized to egg, soy, or peanut. Allergy. 2014;69:388–94.

    Article  CAS  PubMed  Google Scholar 

  120. Hassan NE, Betz BW, Cole MR, Wincek J, Reischman D, Sanfilippo DJ, Winterhalter-Rzeszutko KM, Kopec JS. Randomized controlled trial for intermittent versus continuous propofol sedation for pediatric brain and spine magnetic resonance imaging studies. Pediatr Crit Care Med. 2011;12:e262–5.

    Article  PubMed  Google Scholar 

  121. Chiaretti A, Ruggeiro A, Barone G, Antonelli A, Lazzareschi I, Genovese O, Paiano S, Sammartino M, Maurizi P, Riccardi R. Propofol/alfentanil and propofol/ketamine procedural sedation in children with acute lymphoblastic leukaemia: safety, efficacy and their correlation with pain neuromediator response. Eur J Cancer Care. 2010;19:212–20.

    Article  CAS  Google Scholar 

  122. Dunn MJG, Mitchell R, DeSouza CIB, Drummond GB, Waite A. Recovery from sedation with remifentanil and propofol, compared with morphine and midazolam, for reduction in anterior shoulder dislocation. Emerg Med J. 2011;28:6–10.

    Article  PubMed  Google Scholar 

  123. Tomatir E, Atalay H, Gurses E, Urbay H, Bozkurt P. Effects of low dose ketamine before induction on propofol anesthesia for pediatric magnetic resonance imaging. Pediatr Anesth. 2004;14:845–50.

    Article  Google Scholar 

  124. Daabiss M, Elsherbiny M, Al Otaibi R. Assessment of different concentrations of ketofol in procedural operations. Saudi J Anaesth. 2009;3:15–9.

    Article  Google Scholar 

  125. Andolfatto G, Willman E. A prospective case series of pediatric procedural sedation and analgesia in the emergency department using a single-syringe ketamine-propofol combination (ketofol). Acad Emerg Med. 2010;17:194–201.

    Article  PubMed  Google Scholar 

  126. Short SM, Aun CST. Haemodynamics of propofol in children. Anaesthesia. 1991;46:783–5.

    Article  CAS  PubMed  Google Scholar 

  127. Tobias JD. Prevention of pain associated with the administration of propofol in children: lidocaine versus ketamine. Am J Anesthesiol. 1996;23:231–2.

    Google Scholar 

  128. Picard P, Tramer MR. Prevention of pain on injection with propofol: a quantitative systematic review. Anesth Analg. 2000;90:963–9.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

John W. Berkenbosch’s institution, the University of Louisville/the Kosair Charities Pediatric Clinical Research Unit, has received research funding from Hospira to support the conduct of clinical trials evaluating dexmedetomidine in critically ill children.

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  1. Division of Pediatric Critical Care, Department of Pediatrics, University of Louisville, Kosair Children’s Hospital, 571 S. Floyd, Ste 332, Louisville, KY, 40202, USA

    John W. Berkenbosch

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Berkenbosch, J.W. Options and Considerations for Procedural Sedation in Pediatric Imaging. Pediatr Drugs 17, 385–399 (2015). https://doi.org/10.1007/s40272-015-0140-6

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