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Midazolam as a sole sedative for computed tomography imaging in pediatric patients
Ranju Singh1, Nishant Kumar, Homay Vajifdar
1Department of Anaesthesiology & Critical Care, Lady Hardinge Medical College, Shrimati Sucheta Kriplani Hospital, New Delhi, India. ranjusingh1503@yahoo.com
Insights
Intravenous midazolam effectively sedates children for CT scans, with 90% achieving adequate sedation. This method offers a safe and rapid sedation option for pediatric imaging, minimizing adverse effects and airway complications.
Area of Science:
- Pediatric Anesthesiology
- Radiology
- Pharmacology
Background:
- Sedation is crucial for pediatric computed tomography (CT) imaging to ensure patient cooperation and image quality.
- Intravenous (IV) midazolam is commonly used for procedural sedation, but its efficacy as a sole agent for CT imaging in children requires evaluation.
Purpose of the Study:
- To assess the effectiveness and safety of IV midazolam as a single sedative agent for pediatric CT scans.
- To determine the optimal dosage and evaluate potential adverse effects and complications.
Main Methods:
- A prospective clinical trial involving 516 children (6 months to 6 years) undergoing elective CT scans.
- Administration of IV midazolam at 0.2 mg/kg, with additional boluses up to 0.5 mg/kg if needed.
- Assessment of sedation levels using Ramsay sedation score (RSS), induction time, efficacy, and adverse events.
Main Results:
- Adequate sedation (RSS 3-4) was achieved in 90.12% of patients within 5.9 minutes.
- Only 7.75% required additional midazolam doses, and 2.13% of scans were unsatisfactory.
- Minor side effects like desaturation (6.93%) and hiccups (1.38%) were observed, with no airway complications or aspirations.
Conclusions:
- IV midazolam at 0.2 mg/kg provides adequate sedation for pediatric CT imaging with a low incidence of side effects.
- It is a safe and effective sole agent for sedation in children undergoing CT scans, ensuring rapid recovery and no airway issues.
Objective:
To evaluate the efficacy and adverse effects of i.v. midazolam as a sole agent for sedation in children for computed tomography (CT) imaging.
Materials And Methods:
Prospective clinical trial in which 516 children under ASA classification II-IV (273 boys and 243 girls) in the age group of 6 months to 6 years for elective CT scan were enrolled over a 17-month period. Patients were administered i.v. midazolam 0.2 mg x kg(-1) and further boluses of 0.1 mg x kg(-1) (total 0.5 mg x kg(-1)) if required. Measurements included induction time, efficacy, side effects, complications, and degree of sedation. Sedation was graded on the basis of Ramsay sedation score (RSS) as over sedated (RSS 5-6), adequately sedated (AS, RSS 3-4), under sedated (RSS 1-2), or failed if the procedure could not be completed or another agent had to be administered.
Results:
Of the 516 procedures, 483 brains, 16 chests, and 17 abdomens were scanned with a mean duration of 4.75 +/- 1.75 min with a mean dose of 0.212 mg x kg(-1) of i.v. midazolam. Four hundred and sixty-five (90.12%) patients were AS in 5.9 +/- 0.7 min while 40 (7.75%) patients required additional boluses. Of these 40 patients, 24 (4.65%) required a single bolus, 12 (2.32%) required two boluses, whereas the remaining four (0.78%) required three boluses. In 11 (2.13%; P < 0.0001) patients, the scan could not be completed satisfactorily. Side effects were seen in 46 (9.11%) patients in the form of desaturation, hiccups (seven patients, 1.38%), and agitation (four patients, 0.79%). Desaturation (SpO2 90-95%) was seen in 35 (6.93%) patients, which was corrected by topical application of oxygen. None of the patients exhibited any complications such as pulmonary aspiration or need to maintain airway. The patients were kept under observation for 1 h after the procedure.
Conclusion:
The level of sedation achieved in children with midazolam 0.2 mg x kg(-1) is adequate for imaging with minimal side effects, no airway complications, and fast recovery. It can be recommended as the sole agent for sedation in pediatric patients for CT imaging.
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