Pediatric Radiology

, Volume 44, Issue 2, pp 164–172 | Cite as

Chest CT in children: anesthesia and atelectasis

  • Beverley Newman
  • Elliot J. Krane
  • Rakhee Gawande
  • Tyson H. Holmes
  • Terry E. Robinson
Original Article



There has been an increasing tendency for anesthesiologists to be responsible for providing sedation or anesthesia during chest CT imaging in young children. Anesthesia-related atelectasis noted on chest CT imaging has proven to be a common and troublesome problem, affecting image quality and diagnostic sensitivity.


To evaluate the safety and effectiveness of a standardized anesthesia, lung recruitment, controlled-ventilation technique developed at our institution to prevent atelectasis for chest CT imaging in young children.

Materials and methods

Fifty-six chest CT scans were obtained in 42 children using a research-based intubation, lung recruitment and controlled-ventilation CT scanning protocol. These studies were compared with 70 non-protocolized chest CT scans under anesthesia taken from 18 of the same children, who were tested at different times, without the specific lung recruitment and controlled-ventilation technique. Two radiology readers scored all inspiratory chest CT scans for overall CT quality and atelectasis. Detailed cardiorespiratory parameters were evaluated at baseline, and during recruitment and inspiratory imaging on 21 controlled-ventilation cases and 8 control cases.


Significant differences were noted between groups for both quality and atelectasis scores with optimal scoring demonstrated in the controlled-ventilation cases where 70% were rated very good to excellent quality scans compared with only 24% of non-protocol cases. There was no or minimal atelectasis in 48% of the controlled ventilation cases compared to 51% of non-protocol cases with segmental, multisegmental or lobar atelectasis present. No significant difference in cardiorespiratory parameters was found between controlled ventilation and other chest CT cases and no procedure-related adverse events occurred.


Controlled-ventilation infant CT scanning under general anesthesia, utilizing intubation and recruitment maneuvers followed by chest CT scans, appears to be a safe and effective method to obtain reliable and reproducible high-quality, motion-free chest CT images in children.


Chest CT Infants Atelectasis Lung recruitment Controlled ventilation 



Source of funding: The project was supported by the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through UL1 RR025744, and by the Lucile Packard Foundation for Children's Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Conflicts of interest



  1. 1.
    Kim JE, Newman B (2010) Evaluation of a radiation dose reduction strategy for pediatric chest CT. AJR Am J Roentgenol 194:1188–1193PubMedCrossRefGoogle Scholar
  2. 2.
    Pappas JN, Donnelly LF, Frush DP (2000) Reduced frequency of sedation of young children with multisection helical CT. Radiology 215:897–899PubMedCrossRefGoogle Scholar
  3. 3.
    Sacchetti A, Carraccio C, Giardino A et al (2005) Sedation for pediatric CT scanning: is radiology becoming a drug-free zone? Pediatr Emerg Care 21:295–297PubMedCrossRefGoogle Scholar
  4. 4.
    Slovis TL (2011) Sedation and anesthesia issues in pediatric imaging. Pediatr Radiol 41:514–516PubMedCrossRefGoogle Scholar
  5. 5.
    Long FR, Castile RG (2001) Technique and clinical applications of full-inflation and end-exhalation controlled-ventilation chest CT in infants and young children. Pediatr Radiol 31:413–422PubMedCrossRefGoogle Scholar
  6. 6.
    Stick SM, Brennan S, Murray C et al (2009) Bronchiectasis in infants and preschool children diagnosed with cystic fibrosis after newborn screening. J Pediatr 155:e621CrossRefGoogle Scholar
  7. 7.
    Fleiss JL, Cohen J (1973) The equivalence of weighted kappa and the intraclass correlation coefficient as measures of reliability. Educ Psychol Meas 33:613–619CrossRefGoogle Scholar
  8. 8.
    Rao JN, Scott AJ (1992) A simple method for the analysis of clustered binary data. Biometrics 48:577–585PubMedCrossRefGoogle Scholar
  9. 9.
    Korn E, Graubard BI (1998) Confidence intervals for proportions with small expected number of positive counts estimated from survey data. Surv Methodol 24:193–201Google Scholar
  10. 10.
    Long FR, Williams RS, Adler BH et al (2005) Comparison of quiet breathing and controlled ventilation in the high-resolution CT assessment of airway disease in infants with cystic fibrosis. Pediatr Radiol 35:1075–1080PubMedCrossRefGoogle Scholar
  11. 11.
    Lam WW, Chen PP, So NM et al (1998) Sedation versus general anaesthesia in paediatric patients undergoing chest CT. Acta Radiol 39:298–300PubMedGoogle Scholar
  12. 12.
    Sargent MA, McEachern AM, Jamieson DH et al (1999) Atelectasis on pediatric chest CT: comparison of sedation techniques. Pediatr Radiol 29:509–513PubMedCrossRefGoogle Scholar
  13. 13.
    Rothen HU, Sporre B, Engberg G et al (1998) Airway closure, atelectasis and gas exchange during general anaesthesia. Br J Anaesth 81:681–686PubMedCrossRefGoogle Scholar
  14. 14.
    Kaditis AG, Motoyama EK, Zin W et al (2008) The effect of lung expansion and positive end-expiratory pressure on respiratory mechanics in anesthetized children. Anesth Analg 106:775–785, table of contentsPubMedCrossRefGoogle Scholar
  15. 15.
    Edmark L, Auner U, Enlund M et al (2011) Oxygen concentration and characteristics of progressive atelectasis formation during anaesthesia. Acta Anaesthesiol Scand 55:75–81PubMedCrossRefGoogle Scholar
  16. 16.
    Serafini G, Cornara G, Cavalloro F et al (1999) Pulmonary atelectasis during paediatric anaesthesia: CT scan evaluation and effect of positive endexpiratory pressure (PEEP). Paediatr Anaesth 9:225–228PubMedGoogle Scholar
  17. 17.
    Neumann P, Rothen HU, Berglund JE et al (1999) Positive end-expiratory pressure prevents atelectasis during general anaesthesia even in the presence of a high inspired oxygen concentration. Acta Anaesthesiol Scand 43:295–301PubMedCrossRefGoogle Scholar
  18. 18.
    Tusman G, Bohm SH, Tempra A et al (2003) Effects of recruitment maneuver on atelectasis in anesthetized children. Anesthesiology 98:14–22PubMedCrossRefGoogle Scholar
  19. 19.
    Hanley JA, Lippman-Hand A (1983) If nothing goes wrong, is everything all right? Interpreting zero numerators. JAMA 249:1743–1745PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Beverley Newman
    • 1
  • Elliot J. Krane
    • 2
  • Rakhee Gawande
    • 1
  • Tyson H. Holmes
    • 3
  • Terry E. Robinson
    • 4
  1. 1.Department of RadiologyLucile Packard Children’s HospitalStanfordUSA
  2. 2.Department of Anesthesiology, Perioperative and Pain MedicineStanford University School of Medicine, Lucile Packard Children’s HospitalStanfordUSA
  3. 3.Department of Psychiatry and Behavioral SciencesStanford University School of Medicine, Lucile Packard Children’s HospitalStanfordUSA
  4. 4.Department of Pulmonary Medicine and Cystic Fibrosis Center for Excellence in Pulmonary BiologyStanford University School of Medicine, Lucile Packard Children’s HospitalStanfordUSA

Personalised recommendations