French survey of sedation practices for pediatric magnetic resonance and computed tomography imaging

Valentin Michaud; Baptiste Morel; Catherine Adamsbaum; Bertrand Bruneau; Marion Lenoir; Philippe Petit; Louis-Marie Leiber; Eléonore Blondiaux; Laurent Brunereau; Francis Remérand; Hervé J Brisse; Marc Laffon

doi:10.1007/s00247-023-05635-4

French survey of sedation practices for pediatric magnetic resonance and computed tomography imaging

Pediatr Radiol. 2023 Jul;53(8):1669-1674. doi: 10.1007/s00247-023-05635-4. Epub 2023 Mar 18.

Authors

Affiliations

¹ Anesthesia and Intensive Care Department, University Hospital of Tours, 2 Boulevard Tonnelé, 37044, Tours, France. valentin.michaud@gmail.com.
² UMR 1253, iBrain, Inserm, University of Tours, 37000, Tours, France.
³ Pediatric Radiology Department, University of Paris Saclay, AP-HP, Bicêtre Hospital, 94270, Le Kremlin Bicêtre, France.
⁴ Radiology Department, University Hospital of Rennes, 35200, Rennes, France.
⁵ Radiology Department, University Medical Center, 25000, Besançon, France.
⁶ Pediatric and prenatal imaging unit, Aix Marseille University, La Timone-Enfants Hospital, 13005, Marseille, France.
⁷ Department of Radiology, University Hospital of Angers, 49000, Angers, France.
⁸ Department of Radiology, Trousseau Hospital, APHP, Sorbonne University, 75012, Paris, France.
⁹ Radiology Department, University Hospital of Tours, 37000, Tours, France.
¹⁰ Anesthesia and Intensive Care Department, University Hospital of Tours, 2 Boulevard Tonnelé, 37044, Tours, France.
¹¹ Imaging Department, Institut Curie, 75005, Paris, France.

PMID: 36932258
DOI: 10.1007/s00247-023-05635-4

Abstract

Background: Pediatric magnetic resonance imaging (MRI) and computed tompgraphy (CT) require patient immobility and therefore often require sedation or general anesthesia of patients. Consensus on these procedures is lacking in France.

Objective: Thus, the aim of this study was to describe the current sedation practices for pediatric MRI and CT in France.

Material and methods: From January 2019 to December 2019, an online questionnaire was delivered by electronic mail to a representative radiologist in 60 pediatric radiology centers registered by the French-speaking pediatric and prenatal imaging society. Questions included protocols, drugs used, monitoring and side effects.

Results: Representatives of 40 of the 60 (67%) radiology centers responded to the survey. Among them, 31 performed sedation including 17 (55%) centers where radiologists performed sedation without anesthesiologists present during the procedure. The premedication drugs were hydroxyzine (n = 8, 80%) and melatonin (n = 2, 20%), Sedation drugs used for children ages 0 to 6 years old were pentobarbital (n = 9, 60%), midazolam (n = 2, 13%), chloral hydrate (n = 2, 13%), diazepam (n = 1, 6.5%) and chlorpromazine (n = 1, 6.5%). A written sedation protocol was available in 10/17 (59%) centers. In 6/17 (35%) centers, no monitoring was used during the procedures. Blood pressure monitoring and capnography were rarely used (< 10%) and post-sedation monitoring was heterogeneous. No life-threatening adverse effect was reported, but 6 centers reported at least one incident per year.

Conclusion: For half of the responding radiology centers, radiologists performed sedation alone in agreement with the local anesthesiology team. Sedation procedures and monitoring were heterogenous among centers. Adjustment and harmonization of the practices according to the capacity of each center may be useful.

Keywords: Imaging; Monitoring; Pediatric; Safety; Sedation; Side effects.

MeSH terms

Child
Child, Preschool
Chloral Hydrate* / adverse effects
Conscious Sedation / adverse effects
Humans
Hypnotics and Sedatives*
Infant
Infant, Newborn
Magnetic Resonance Imaging
Magnetic Resonance Spectroscopy
Surveys and Questionnaires
Tomography, X-Ray Computed

Substances

Hypnotics and Sedatives
Chloral Hydrate