From the Guidelines
Midazolam is the most appropriate sedative for a pediatric patient to undergo Computed Tomography (CT).
Sedation Options
- Midazolam is a commonly used benzodiazepine for sedation in pediatric patients, offering effective relief for anxious children 1.
- Nitrous oxide is another option, but it has a failure rate of 20 to 30% and is less effective in children under 3 years 1.
- Hydroxyzine is a sedative antihistamine approved for anxiolytic use, but its use may be limited due to contraindications in certain children 1.
Administration and Monitoring
- Sedation should only be administered by authorized, qualified personnel, such as an anesthetist or equally trained physician, according to hospital and national regulations 1.
- The depth of sedation should be carefully monitored, and the imaging department must have sufficient human and technical resources, including monitoring devices and emergency equipment 1.
Considerations
- The decision to sedate a child must be made on an individual basis, taking into account the child's age, medical history, and the specific procedure being performed 1.
- The use of sedation should be minimized whenever possible, and non-pharmacological options, such as audio-visual entertainment and cognitive behavioral strategies, should be considered to reduce anxiety and improve cooperation 1.
From the Research
Sedation Options for Pediatric CT Scans
The choice of sedative for pediatric patients undergoing Computed Tomography (CT) scans depends on various factors, including the patient's age, medical history, and the specific requirements of the procedure. Several studies have compared the efficacy and safety of different sedatives in this context.
Comparison of Sedatives
- Etomidate and pentobarbital were compared in a study published in 2007 2, which found that etomidate was more effective and efficient, with fewer adverse events.
- Midazolam was evaluated as a sole sedative for CT imaging in pediatric patients in a 2009 study 3, which found that it was effective and well-tolerated, with minimal side effects.
- A 2017 study compared oral midazolam with intranasal dexmedetomidine for CT imaging in children 4, and found that dexmedetomidine was superior in producing satisfactory sedation.
- Dexmedetomidine was also compared with pentobarbital in a 2011 study 5, which found that dexmedetomidine was associated with a shorter recovery time and less need for adjuvant sedatives.
Sedation Requirements
- A 2005 study found that sedation was infrequently used in infants and young children undergoing helical CT studies 6, suggesting that the need for sedation may be decreasing with the use of faster CT scanners.
Key Findings
- Etomidate and dexmedetomidine appear to be effective and safe sedatives for pediatric CT scans, with fewer adverse events compared to pentobarbital.
- Midazolam is also a viable option, particularly when used as a sole sedative.
- The choice of sedative should be individualized based on the patient's specific needs and medical history.