Background Children who need MRI scanning frequently need sedation in order to remain still for the procedure. This poses a number of potential problems including the organisational difficulties in ensuring that the child is admitted, sedated and scanned all in a timely, coordinated and safe manner.
Hospital protocol for Imaging under sedation in children
Chloral Hydrate orally (50-100 mg/Kg, max 2 g: Ref BNF 2008: 211) is prescribed to be administered 45 mins before scan. If the child is not adequately sedated 15 mins before the planned scan time then intravenous midazolam (50-100 mcg/Kg in steps up to max of 300 mcg/Kg) may be given. All sedated children must have continuous oximetry and have facilities available for bag-and-mask ventilation.
Methods We conducted an audit to review our practice by examining our safety and success rates. The medical notes of 56 patients from June 2009-December 2010 were reviewed. We looked at the age, gender, date, indication, emergency/planned, oral Chloral Hydrate, IV midazolam, accompanied by SHO/SpR, success rate, complications, result, picture quality and whether any repeat scan was required.
Results The majority of scans were performed as planned procedures. 54 (98%) patients received oral chloral hydrate 50-100 mg/kg and 44 (82%) of them received IV midazolam 100 mcg/kg. Only 12 (28%) of the midazolam group required a further dose. 47 (84%) had successful sedation with good quality pictures and only 4 required a repeat scan. We found that most patients were pre school children, 33 (60%) were aged 1-5 years. Half of our patients were accompanied by SpRs during the procedure and no complications were reported. The commonest indication was for seizures and the majority of scan results showed incidental findings only.
Conclusions We had a high success rate when compared with published data and we considered whether this was due to the frequent use of midazolam or because Chloral Hydrate was used in conjunction with the midazolam. In addition, these children should be accompanied by a doctor competent in paediatric airway management. We believe implementation of this protocol in children is safe, successful and cost effective.