SPA Newsletter

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David S Beebe, Tran P, Bragg M, Stillman A, Truwitt C, Belani KG. Canadian Journal of Anesthesia 2000; 47:205-210.

Review: This study is a retrospective review of 572 MRI scans done on 488 patients over the 3 year start up period for a new sedation protocol. The nurses selected to perform sedation for these procedures had all worked in postanesthesia care units and underwent an education process including instruction in airway management, PALS, sedation agents, monitoring, assessment and vascular access. Each subject received sedation based on a protocol standardized with regard to age, use of contrast and level of sedation. The radiologist was responsible and in attendance for each child sedated and functioned as the medical supervisor.

Approximately 92% of patients were successfully sedated for MRI. The primary reasons for failure were inadequate sedation (95.7%) and coughing (4.2%). Failure was much higher in the earlier half of the study (38/272, 14%) than the second half (9/300, 3%). Failure was also higher with the use of rectal thoipental (14%) than intravenous pentobarbital (7.4%). Patients with previous behavioral disorders also had a higher incidence of failure (17%). Hypoxeia was not recorded, no deaths or unexpected admissions occurred.

Commentary: This study looks at a more standardized protocol for sedation. The authors noted a lower failure rate than the previous study. However, most importantly, the failure rate dropped during the second half of the study by 75%. This leads to the assumption that a combination of experience and training for sedation nurses is the best indicator of success for these sedation protocols. Further, the authors note that the incidence of failed sedation at their institution is now less that 2%.

Reviewed by: Jeffrey Galinkin, MD
Children's Hospital of Philadelphia