What is the best medication to calm anxiety during imaging scans in an inpatient setting?

From the Guidelines

For inpatient imaging scans, midazolam is the preferred medication to calm patients due to its rapid onset and short duration of action, as evidenced by its common use in conscious sedation during procedures 1. When considering sedation for inpatient imaging scans, the goal is to minimize anxiety and discomfort while ensuring the patient's safety and the success of the procedure.

• Key factors influencing the choice of sedation include the patient's medical history, the type of imaging study, and the availability of monitoring equipment and personnel.
• Benzodiazepines, such as midazolam, lorazepam, and temazepam, are frequently used for conscious sedation because they offer anxiolysis and amnesia with relatively short durations of action, as noted in the guideline on anaesthesia and sedation in breastfeeding women 2020 1.
• Midazolam, in particular, is advantageous for its quick onset of action (within 2-3 minutes) and short half-life (approximately 1.5 to 2.5 hours), making it suitable for brief procedures like imaging scans.
• The typical initial dose of midazolam for sedation during imaging scans is 1-2 mg IV, with additional doses given as needed up to a maximum of 5 mg, depending on the patient's response and the procedure's requirements.
• It's crucial to monitor patients closely for signs of respiratory depression, a potential side effect of benzodiazepines, and to have personnel and equipment available to manage any adverse effects.
• For patients who may not be suitable for benzodiazepines or who require deeper sedation, alternative agents like propofol may be considered, although this necessitates more intensive monitoring due to its potential for significant respiratory and cardiovascular effects.

From the FDA Drug Label

Sedative doses should be individually titrated, taking into account patient age, clinical status and concomitant use of other CNS depressants. Midazolam should always be titrated slowly; administer over at least 2 minutes and allow an additional 2 or more minutes to fully evaluate the sedative effect. Healthy Adults Below the Age of 60: Titrate slowly to the desired effect, e.g., the initiation of slurred speech. Some patients may respond to as little as 1 mg. No more than 2.5 mg should be given over a period of at least 2 minutes. Patients Age 60 or Older, and Debilitated or Chronically Ill Patients: Because the danger of hypoventilation, airway obstruction, or apnea is greater in elderly patients and those with chronic disease states or decreased pulmonary reserve, and because the peak effect may take longer in these patients, increments should be smaller and the rate of injection slower.

The best medication to calm during imaging scans inpatient is midazolam (IV). The dosage should be individually titrated, taking into account the patient's age, clinical status, and concomitant use of other CNS depressants.

• For healthy adults below 60, the recommended dose is 1-2.5 mg over at least 2 minutes.
• For patients 60 or older, and debilitated or chronically ill patients, the recommended dose is 1-1.5 mg over at least 2 minutes, with slower increments and a lower total dose. 2

From the Research

Medications for Calming During Imaging Scans

• The most effective medication for calming during imaging scans is not explicitly stated in the provided studies, as they focus on non-pharmacologic interventions and comparisons between different sedation techniques 3, 4, 5, 6, 7.
• However, propofol and dexmedetomidine are commonly used medications for sedation during MRI procedures, with propofol showing better outcomes in terms of timeliness, emergence characteristics, and parental satisfaction in children undergoing lengthy multicomponent MRI 6.
• Benzodiazepines and opioids are also traditionally used for managing anxiety and pain during image-guided procedures, but their use carries the risk of adverse events 3.

Non-Pharmacologic Interventions

• Non-invasive, non-pharmacologic techniques such as hypnosis, structured empathic attention, anodyne imagery, music, video glasses, and mobile applications have evolved to address patient needs and reduce procedural anxiety and pain 3.
• Improving communication between patients and technologists, such as through the use of a call device, can also reduce patient anxiety during imaging procedures 4.
• Interventions like MRI design features, cognitive-behavioral strategies, prone positioning, information, fragrance administration, and team training have been found to have a positive impact on reducing anxiety and claustrophobia in patients undergoing MRI 5, 7.

Patient Outcomes

• Reducing anxiety in patients undergoing imaging scans can have a positive effect on the quality of the scan, patient comfort, and overall experience 4, 5, 7.
• Interventions aimed at reducing anxiety, claustrophobia, and sedation can also improve patient satisfaction and reduce non-completion rates of imaging procedures 7.