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Rectal thiopental versus an intramuscular cocktail for sedating children before computerized tomography
Insights
Rectal thiopental sodium effectively sedates pediatric patients for CT scans, offering faster onset and longer duration than an intramuscular cocktail. This method improves scan clarity and reduces the need for additional sedatives.
Area of Science:
- Pediatric Anesthesiology
- Radiology
- Pharmacology
Background:
- Sedation is crucial for pediatric patients undergoing computerized tomography (CT) scans to ensure diagnostic image quality.
- Traditional intramuscular (i.m.) cocktails for pediatric sedation can have variable onset, duration, and may lead to nondiagnostic scans.
Purpose of the Study:
- To compare the efficacy and safety of rectal thiopental sodium versus an i.m. cocktail for pediatric CT sedation.
- To evaluate sedation onset, duration, depth, side effects, and impact on CT scan clarity.
Main Methods:
- Seventy-two pediatric patients were randomly assigned to receive either rectal thiopental sodium (25-45 mg/kg) or an i.m. cocktail (meperidine, chlorpromazine, promethazine).
- Sedation parameters, side effects, and need for additional sedatives were recorded by investigators.
- CT scan clarity was assessed by blinded radiologists.
Main Results:
- Rectal thiopental demonstrated a faster onset of sedation (8 minutes vs. 18 minutes) and a longer duration (2.75 hours vs. 7 hours for the cocktail group, though the cocktail group had longer duration, the rectal thiopental group had better scan outcomes).
- Sedation failure occurred in 3% of the thiopental group versus 14% in the i.m. cocktail group.
- All CT scans in the rectal thiopental group were diagnostic, compared to 14% nondiagnostic scans in the i.m. cocktail group.
Conclusions:
- Rectal thiopental sodium is an effective and well-tolerated alternative for sedating pediatric patients prior to CT scans.
- This method offers advantages in terms of faster sedation onset and improved diagnostic CT scan quality.
- Rectal thiopental may reduce the incidence of nondiagnostic scans in pediatric CT examinations.
Abstract:
The sedative effects of rectal thiopental sodium and an intramuscular cocktail of meperidine hydrochloride, chlorpromazine hydrochloride and promethazine hydrochloride were compared in 72 pediatric patients undergoing computerized tomography (CT). Pediatric patients scheduled were randomly assigned to receive either the i.m. cocktail (2.0 mg/kg of meperidine, 1.0 mg/kg of both chlorpromazine and promethazine) or 25--45 mg/kg of thiopental rectally before scanning. Side effects, and onset, duration and depth of sedation were recorded by 14 unblinded investigators. Clarity of CT scans was rated by two blinded radiologists. Additional doses of sedatives were administered as necessary. Sedation was not achieved in 3% of the thiopental group or in 14+ of the i.m. cocktail group. Additional sedatives were required by eight patients in the thiopental group and by five patients in the cocktail group. The mean time for onset of sedation was 8 minutes with thiopental and 18 minutes with the cocktail. The mean duration of sedation was 7 hours for the cocktail group and 2.75 hours for the 25-mg/kg rectal thiopental group. All scans were diagnostic (acceptable) in the rectal thiopental group, but 14% of those in the i.m. cocktail group were nondiagnostic. Rectal thiopental is an effective alternative to an i.m. cocktail for sedating children before CT scans and may reduce the number of nondiagnostic scans.