Canadian Journal of Anaesthesia

, Volume 47, Issue 3, pp 205–210 | Cite as

Trained nurses can provide safe and effective sedation for MRI in pediatric patients

  • David S Beebe
  • Phuc Tran
  • Margaret Bragg
  • Arthur Stillman
  • Charles Truwitt
  • Kumar G. Belani
Reports Of Investigation

Abstract

Purpose: To determine the success rate, safety and complications using a standard protocol and trained nurses to provide sedation for MRI under the supervision of a radiologist.

Materials and Methods: Nurses were trained to provide sedation via a standard protocol for pediatric patients undergoing diagnostic MRI. Oral chloral hydrate (80–100 mg·kg−1) was used for children less than 18 mo of age. Older children received either 1–6 mg·kg−1 pentobarbitaliv, with or without 1–2 µg·kg·hr−1 fentanyl, or 25 mg·kg−1 thiopentalpr. Sedation was defined as successful if it allowed completion of the MRI without image distorting patient movement. The records of 572 MRIs performed on 488 pediatric patients (mean age 5±4 yr; age 2 mo-14 yr) from 1991 to July 1995 were reviewed to determine the success rate and complications using the sedation program.

Results: Most, 91.8% (525/572), of the MRIs were successfully completed in 445 patients. The reasons for failure were inadequate sedation (45, 95.7%) and coughing (2, 4.2%). The failure rate was much higher before 1994 (38/272, 14%) than after (9/300, 3%;P<0.0001). Failure was more common if rectal thiopental was used (23/172, 14%) than intravenous pentobarbital (19/256, 7.4%;P<0.05). The failure rate was also high in patients with a history of a behavioural disorder (10/59, 17%). There were no deaths or unexpected admissions as a result of the sedation program.

Conclusion: A high success rate can be achieved as experience is gained using a standard protocol and trained nurses to sedate children for MRI.

Résumé

Objectif: Évaluer le taux de succès, la sécurité et les complications liés à l’usage, par du personnel infirmier formé, d’un protocole standard d’administration d’une sédation en vue d’un examen d’IRM sous la supervision d’un radiologiste.

Méthode: Des infirmières ont été formées pour administrer la sédation selon un protocole standard à des patients pédiatriques devant subir un examen diagnostique d’IRM. L’hydrate de chloral oral (80–100 mg·kg−1) a servi pour les enfants de moins de 18 mois. Les plus âgés ont reçu soit 1–6 mg·kg−1 de pentobarbitaliv, avec ou sans 1–2 µg·kg·hr−1 de fentanyl, soit 25 mg·kg−1 de thiopentalpr. On considérait la sédation résussie quand l’IRM était achevé sans distorsion d’image par un mouvement du patient. Les enregistrements de 572 IRM réalisés chez 488 enfants (âge moyen de 5±4 ans; limite d’âge de 2 mois-14 jrs) de 1991 à juillet 1995 ont été revus pour l’évaluation du taux de succès et des complications liés au programme de sédation.

Résultats: La plupart des examend d’IRM, 91,8 % (525/572), ont été réalisés avec succès chez 445 patients. Les échecs ont eu pour cause une sédation insuffisante (45, 95,7 %) et la toux (2, 4,2 %). Le taux d’échec a été beaucoup plus élevé avant 1994 (38/272, 14 %) qu’après (9/300, 3 %P < 0,0001). L’échec était plus fréquent avec l’usage de thiopental rectal (23/172, 14 %) qu’avec le pentobarbital intravenieux (19/256, 7,4 %;P<0,05). Le taux d’échec a été élevé également chez les patients qui présentaient des antécédents de troubles de comportement (10/59, 17 %). Aucun cas de décès ou d’admission imprévue n’a résulté de ce programme de sédation.

Conclusion: Unb for taux de réussite peut être atteint à mesure que se développe l’expérience des infirmières formées à utiliser un protocole standard d’administration d’une sédation à des enfants pour un examen d’IRM.

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Copyright information

© Canadian Anesthesiologists 2000

Authors and Affiliations

  • David S Beebe
    • 1
  • Phuc Tran
    • 1
  • Margaret Bragg
    • 2
  • Arthur Stillman
    • 2
  • Charles Truwitt
    • 2
  • Kumar G. Belani
    • 1
    • 3
  1. 1.From the Department of AnesthesiologyUniversity of Minnesota Medical SchoolMinneapolisUSA
  2. 2.Department of RadiologyUniversity of Minnesota Medical SchoolMinneapolisUSA
  3. 3.Department of PediatricsUniversity of Minnesota Medical SchoolMinneapolisUSA

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