Skip to main content

Sedation and General Anesthesia

  • Chapter
  • First Online:
  • 2424 Accesses

Abstract

Sedation and general anesthesia are required for certain patients who are scheduled for nuclear medicine imaging. The creation of a credentialed anesthesia and sedation service will enhance the efficiency of the radiology/nuclear medicine department while promoting safe care of pediatric patients. The nuclear medicine setting is unique and poses inherent challenges. There is a need for ongoing discussions among the providers of sedation and anesthesia, the nuclear medicine nurses, technologists, and physicians.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Mandell GA, Cooper JA, Majd M, Shalaby-Rana EI, Gordon I. Procedure guideline for pediatric sedation in nuclear medicine. Society of Nuclear Medicine. J Nucl Med. 1997;38(10):1640–3.

    CAS  PubMed  Google Scholar 

  2. Treves ST, Baker A, Fahey FH, et al. Nuclear medicine in the first year of life. J Nucl Med. 2011;52(6):905–25.

    Article  PubMed  Google Scholar 

  3. Mason KP, Sanborn P, Zurakowski D, et al. Superiority of pentobarbital versus chloral hydrate for sedation in infants during imaging. Radiology. 2004;230(2):537–42.

    Article  PubMed  Google Scholar 

  4. Cote CJ, Wilson S. Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures: an update. Pediatrics. 2006;118(6):2587–602.

    Article  PubMed  Google Scholar 

  5. Kaplan RF, Cravero JP, Yaster M, Cote C. Chap. 48. Sedation for diagnostic and therapeutic procedures outside the operating room. In: Cote CJ, Lerman J, Todres ID, editors. A practice of anesthesia for infants and children. Philadelphia: Saunders/Elsevier; 2009. p. 1023–48.

    Chapter  Google Scholar 

  6. American Society of Anesthesiologists Task Force on Sedation and Analgesia. Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology. 2002;96(4):1004–17.

    Article  Google Scholar 

  7. Practice guidelines for sedation and analgesia by non-anesthesiologists. A report by the American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists. Anesthesiology. 1996;84(2):459–71.

    Google Scholar 

  8. Guidelines for the elective use of conscious sedation, deep sedation, and general anesthesia in pediatric patients. Committee on Drugs. Section on anesthesiology. Pediatrics. 1985;76(2):317–21.

    Google Scholar 

  9. American Academy of Pediatrics Committee on Drugs. Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures. Pediatrics. 1992;89(6 Pt 1):1110–5.

    Google Scholar 

  10. Committee on Drugs. American Academy of Pediatrics. Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures: addendum. Pediatrics. 2002;110(4):836–8.

    Google Scholar 

  11. Keeter S, Benator RM, Weinberg SM, Hartenberg MA. Sedation in pediatric CT: national survey of current practice. Radiology. 1990;175(3):745–52.

    CAS  PubMed  Google Scholar 

  12. Joint Commission for Accreditation of Hospitals (JCAHO). Operative or other high-risk procedures and/or the administration of moderate or deep sedation or anesthesia. The Comprehensive accreditation manual for Hospitals: official handbook. Oakbrook Terrace: JCAHO; 2007. p. PC-41.

    Google Scholar 

  13. Department of Health & Human Services. Centers for Medicare & Medicaid Services. Revised hospital anesthesia services interpretive guidelines – state operations manual (SOM) Appendix A Ref: S&C- 10-09-Hospital. Revised 2 May 2010. https://www.cms.gov/SurveyCertificationGenInfo/downloads/SCLetter10_09.pdf. Accessed 14 Feb 2011.

  14. Department of Health & Human Services. Centers for Medicare & Medicaid Services. CMS Manual System. Pub. 100–07 State Operations Provider Certification. Transmittal 59. Clarification of the interpretive guidelines for the anesthesia services condition of participation. 21 May 2010. https://www.cms.gov/transmittals/downloads/R59SOMA.pdf. Accessed 20 Jan 2011.

  15. McQuattie S. Pediatric PET/CT imaging: tips and techniques. J Nucl Med Technol. 2008;36(4):171–80.

    Article  PubMed  Google Scholar 

  16. Mallory MD, Baxter AL, Yanosky DJ, Cravero JP. Emergency physician-administered propofol sedation: a report on 25,433 sedations from the pediatric sedation research consortium. Ann Emerg Med. 2011;57(5):462–8.1.

    Article  PubMed  Google Scholar 

  17. Cravero JP, Beach ML, Blike GT, Gallagher SM, Hertzog JH. 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(3):795–804.

    Article  CAS  PubMed  Google Scholar 

  18. Srinivasan M, Turmelle M, Depalma LM, Mao J, Carlson DW. Procedural sedation for diagnostic imaging in children by pediatric hospitalists using propofol: analysis of the nature, frequency, and predictors of adverse events and interventions. J Pediatr. 2012;160(5):801–6.e1.

    Article  PubMed  Google Scholar 

  19. Mason KP, Fontaine PJ, Robinson F, Zgleszewski S. Pediatric sedation in a community hospital-based outpatient MRI center. AJR Am J Roentgenol. 2012;198(2):448–52.

    Article  PubMed  Google Scholar 

  20. Vespasiano M, Finkelstein M, Kurachek S. Propofol sedation: intensivists’ experience with 7304 cases in a children’s hospital. Pediatrics. 2007;120(6):e1411–7.

    Article  PubMed  Google Scholar 

  21. American Society of Anesthesiologists. Statement on Nonoperating Room Anesthetizing Locations. http://www.asahq.org/For-Members/~/media/For%20Members/documents/Standards%20Guidelines%20Stmts/Nonoperating%20Room%20Anesthetizing%20Locations.ashx. Accessed 12 March 2013

  22. Sanborn PA, Michna E, Zurakowski D, et al. Adverse cardiovascular and respiratory events during sedation of pediatric patients for imaging examinations. Radiology. 2005;237(1):288–94.

    Article  PubMed  Google Scholar 

  23. Maxwell LG, Tobias JD, Cravero JP, Malviya S. Adverse effects of sedatives in children. Expert Opin Drug Saf. 2003;2(2):167–94.

    Article  CAS  PubMed  Google Scholar 

  24. Metzner J, Posner KL, Domino KB. The risk and safety of anesthesia at remote locations: the US closed claims analysis. Curr Opin Anaesthesiol. 2009;22(4):502–8.

    Article  PubMed  Google Scholar 

  25. Bhananker SM, Posner KL, Cheney FW, Caplan RA, Lee LA, Domino KB. Injury and liability associated with monitored anesthesia care: a closed claims analysis. Anesthesiology. 2006;104(2):228–34.

    Article  PubMed  Google Scholar 

  26. Prescilla R. Pharmacology and clinical applications of sedatives, analgesics, and adjuncts. In: Mason K, Koka B, editors. Pediatric sedation outside the operating room: a multispecialty collaboration. New York: Springer; 2011. p. 93–122.

    Google Scholar 

  27. American Academy of Pediatrics Committee on Drugs and Committee on Environmental Health: use of chloral hydrate for sedation in children. Pediatrics. 1993;92(3):471–3.

    Google Scholar 

  28. Ferrer-Brechner T, Winter J. Anesthetic considerations for cerebral computer tomography. Anesth Analg. 1977;56(3):344–7.

    Article  CAS  PubMed  Google Scholar 

  29. Greenberg SB, Faerber EN, Aspinall CL, Adams RC. High-dose chloral hydrate sedation for children undergoing MR imaging: safety and efficacy in relation to age. AJR Am J Roentgenol. 1993;161(3):639–41.

    Article  CAS  PubMed  Google Scholar 

  30. Greenberg SB, Faerber EN, Aspinall CL. High dose chloral hydrate sedation for children undergoing CT. J Comput Assist Tomogr. 1991;15(3):467–9.

    Article  CAS  PubMed  Google Scholar 

  31. Napoli KL, Ingall CG, Martin GR. Safety and efficacy of chloral hydrate sedation in children undergoing echocardiography. J Pediatr. 1996;129(2):287–91.

    Article  CAS  PubMed  Google Scholar 

  32. Thompson JR, Schneider S, Ashwal S, Holden BS, Hinshaw Jr DB, Hasso AN. The choice of sedation for computed tomography in children: a prospective evaluation. Radiology. 1982;143(2):475–9.

    CAS  PubMed  Google Scholar 

  33. 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 Ther. 1994;19(4):239–43.

    Article  CAS  PubMed  Google Scholar 

  34. Chung T, Hoffer FA, Connor L, Zurakowski D, Burrows PE. The use of oral pentobarbital sodium (Nembutal) versus oral chloral hydrate in infants undergoing CT and MR imaging–a pilot study. Pediatr Radiol. 2000;30(5):332–5.

    Article  CAS  PubMed  Google Scholar 

  35. Mason KP, Zurakowski D, Connor L, et al. Infant sedation for MR imaging and CT: oral versus intravenous pentobarbital. Radiology. 2004;233(3):723–8.

    Article  PubMed  Google Scholar 

  36. Macias CG, Chumpitazi CE. Sedation and anesthesia for CT: emerging issues for providing high-quality care. Pediatr Radiol. 2011;41 Suppl 2:517–22.

    Article  PubMed  Google Scholar 

  37. Evers AS, Crowder CM, Balser JR. General anesthetics. In: Brunton LL, Laso JS, Parker KL, editors. Goodman and Gilman’s the pharmacological basis of therapeutics. 11th ed. New York: McGraw-Hill; 2006.

    Google Scholar 

  38. Hall JE, Uhrich TD, Barney JA, Arain SR, Ebert TJ. Sedative, amnestic, and analgesic properties of small-dose dexmedetomidine infusions. Anesth Analg. 2000;90(3):699–705.

    Article  CAS  PubMed  Google Scholar 

  39. Talke P, Lobo E, Brown R. Systemically administered alpha2-agonist-induced peripheral vasoconstriction in humans. Anesthesiology. 2003;99(1):65–70.

    Article  CAS  PubMed  Google Scholar 

  40. Talke P, Richardson CA, Scheinin M, Fisher DM. Postoperative pharmacokinetics and sympatholytic effects of dexmedetomidine. Anesth Analg. 1997;85(5):1136–42.

    CAS  PubMed  Google Scholar 

  41. Bamgbade OA. Dexmedetomidine for peri-operative sedation and analgesia in alcohol addiction. Anaesthesia. 2006;61(3):299–300.

    Article  CAS  PubMed  Google Scholar 

  42. Jackson 3rd KC, Wohlt P, Fine PG. Dexmedetomidine: a novel analgesic with palliative medicine potential. J Pain Palliat Care Pharmacother. 2006;20(2):23–7.

    PubMed  Google Scholar 

  43. Rich JM. Dexmedetomidine as a sole sedating agent with local anesthesia in a high-risk patient for axillofemoral bypass graft: a case report. AANA J. 2005;73(5):357–60.

    PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  45. Precedex (dexmedetomidine hydrochloride) Hospira, Inc. Lake Forest, IL 60045 USA. http://www.precedex.com/wp-content/uploads/Precedex_PI.pdf. Accessed 12 March 2013.

  46. Belleville JP, Ward DS, Bloor BC, Maze M. Effects of intravenous dexmedetomidine in humans. I. Sedation, ventilation, and metabolic rate. Anesthesiology. 1992;77(6):1125–33.

    Article  CAS  PubMed  Google Scholar 

  47. Ingersoll-Weng E, Manecke Jr GR, Thistlethwaite PA. Dexmedetomidine and cardiac arrest. Anesthesiology. 2004;100(3):738–9.

    Article  PubMed  Google Scholar 

  48. Scheinin H, Aantaa R, Anttila M, Hakola P, Helminen A, Karhuvaara S. Reversal of the sedative and sympatholytic effects of dexmedetomidine with a specific alpha2-adrenoceptor antagonist atipamezole: a pharmacodynamic and kinetic study in healthy volunteers. Anesthesiology. 1998;89(3):574–84.

    Article  CAS  PubMed  Google Scholar 

  49. Venn RM, Bradshaw CJ, Spencer R, et al. Preliminary UK experience of dexmedetomidine, a novel agent for postoperative sedation in the intensive care unit. Anaesthesia. 1999;54(12):1136–42.

    Article  CAS  PubMed  Google Scholar 

  50. Mason KP, Robinson F, Fontaine PJ, Prescilla R. Dexmedetomidine offers an option for safe and effective sedation for nuclear medicine imaging in children. Radiology. 2013;267(3):911–7.

    Article  PubMed  Google Scholar 

  51. Way WL, Trevor AJ. Pharmacology of intravenous nonnarcotic anesthetics. In: Anesthesia. 2nd ed. New York: Churchill Livingstone; 1986. p. 813–7.

    Google Scholar 

  52. Drummond GB. Comparison of sedation with midazolam and ketamine: effects on airway muscle activity. Br J Anaesth. 1996;76(5):663–7.

    Article  CAS  PubMed  Google Scholar 

  53. Fine J, Finestone SC. Sensory disturbances following ketamine anesthesia: recurrent hallucinations. Anesth Analg. 1973;52(3):428–30.

    Article  CAS  PubMed  Google Scholar 

  54. Meyers EF, Charles P. Prolonged adverse reactions to ketamine in children. Anesthesiology. 1978;49(1):39–40.

    Article  CAS  PubMed  Google Scholar 

  55. Roelofse JA, Joubert JJ, Roelofse PG. A double-blind randomized comparison of midazolam alone and midazolam combined with ketamine for sedation of pediatric dental patients. J Oral Maxillofac Surg. 1996;54(7):838–44; discussion 845–6.

    Article  CAS  PubMed  Google Scholar 

  56. 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(3):229–38.

    Article  CAS  PubMed  Google Scholar 

  57. Green SM, Johnson NE. Ketamine sedation for pediatric procedures: part 2, review and implications. Ann Emerg Med. 1990;19(9):1033–46.

    Article  CAS  PubMed  Google Scholar 

  58. Hollister GR, Burn JM. Side effects of ketamine in pediatric anesthesia. Anesth Analg. 1974;53(2):264–7.

    Article  CAS  PubMed  Google Scholar 

  59. 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(6):579–88.

    Article  CAS  PubMed  Google Scholar 

  60. Sussman DR. A comparative evaluation of ketamine anesthesia in children and adults. Anesthesiology. 1974;40(5):459–64.

    Article  CAS  PubMed  Google Scholar 

  61. Frankville DD, Spear RM, Dyck JB. The dose of propofol required to prevent children from moving during magnetic resonance imaging. Anesthesiology. 1993;79(5):953–8.

    Article  CAS  PubMed  Google Scholar 

  62. Evans RG, Crawford MW, Noseworthy MD, Yoo SJ. Effect of increasing depth of propofol anesthesia on upper airway configuration in children. Anesthesiology. 2003;99(3):596–602.

    Article  CAS  PubMed  Google Scholar 

  63. Reber A, Wetzel SG, Schnabel K, Bongartz G, Frei FJ. Effect of combined mouth closure and chin lift on upper airway dimensions during routine magnetic resonance imaging in pediatric patients sedated with propofol. Anesthesiology. 1999;90(6):1617–23.

    Article  CAS  PubMed  Google Scholar 

  64. Pambianco DJ, Vargo JJ, Pruitt RE, Hardi R, Martin JF. Computer-assisted personalized sedation for upper endoscopy and colonoscopy: a comparative, multicenter randomized study. Gastrointest Endosc. 2011;73(4):765–72.

    Article  PubMed  Google Scholar 

  65. Rex DK, Deenadayalu VP, Eid E, et al. Endoscopist-directed administration of propofol: a worldwide safety experience. Gastroenterology. 2009;137(4):1229–37; quiz 1518–29.

    Article  PubMed  Google Scholar 

  66. Veenith T, Coles JP. Anaesthesia for magnetic resonance imaging and positron emission tomography. Curr Opin Anaesthesiol. 2011;24(4):451–8.

    Article  PubMed  Google Scholar 

  67. Roberts EG, Shulkin BL. Technical issues in performing PET studies in pediatric patients. J Nucl Med Technol. 2004;32(1):5–9; quiz 10–11.

    PubMed  Google Scholar 

Download references

Acknowledgments

We wish to thank Joanne Louis, CNMT, for her technical review and Ms. Amanda Buckley for the editorial assistance and preparation of this chapter.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Randy P. Prescilla MD .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer Science+Business Media New York

About this chapter

Cite this chapter

Prescilla, R.P., Mason, K.P. (2014). Sedation and General Anesthesia. In: Treves, S. (eds) Pediatric Nuclear Medicine and Molecular Imaging. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-9551-2_2

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-9551-2_2

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-9550-5

  • Online ISBN: 978-1-4614-9551-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics