Parents shouldn't be too concerned when their children need conscious sedation or general anesthesia -- even when daily sedation is required. According to a Saudi researcher who spoke at last week's RSNA meeting, conscious sedation and general anesthesia are both safe, but the latter is faster.
Dr. Mohammad Al Shabanah from the King Faisal Specialist Hospital and Research Center in Riyadh, Saudi Arabia presented the results of a two-year study of 198 pediatric cancer patients (ages 9 months to 14 years) who underwent 4,232 radiation treatment or simulation procedures. Thirty-seven percent of pediatric patients ages 15 and under required sedation prior to radiation treatment. In all, 73 patients were sedated an average of 14 times each in 1,033 sedation procedures, Al Shabanah said.
"The objectives were to ensure the safety and welfare of the patient, to evaluate our reasons for selecting patients for sedation, to evaluate the different [methods], the ability to return the patient to a state in which safe discharge is possible, and the opportunity to combine sedation regimens," Al Shabanah said.
Patients were chosen for sedation according to five criteria, including age, immaturity, anxiety, noncompliance, and complexity of treatment.
"Anxiety was actually not a good predictor of need, because 20% of patients [chosen for that reason] did not need sedation," Al Shabanah said. "So, of 73 patients selected for sedation, 63 required sedation, so there was correct selection 86% of the time."
All patients in the prospective nonrandomized study initially received conscious (CS) sedation rather than general anesthesia (GA). CS patients who needed a chloral hydrate boost proceeded to GA, according to Al Shabanah. In all, 86% (883) of sedations were performed using GA, and 14% using CS.
Seventy-nine patients were treated in a supine position, 21 were prone, and 86% required a mold -- most of them for patients with head and neck tumors, he said. Ninety-six percent had some form of IV access, most commonly a portacath (76%).
According to the results, satisfactory sedation was achieved in 97% of patients with GA, but in only 68% of patients using CS. In multivariate analysis, the only significant factor predicting a successful outcome was GA using propofol versus CS.
"The odds of satisfactory treatment with propofol were more than 20 times [that of] using chloral hydrate, or meperidine or midazolam," he said (P = 0.0001).
"Chloral hydrate, we think, should not be used," he said, noting complications in 23% of these patients, mainly vomiting and tachycardia, and effectiveness of only 60%. "Propofol is the most useful [for GA], midazolam if using conscious sedation, but you need an IV."
No serious complications resulted from the sedation of any patient, Al Shabanah said. Vomiting (18 instances) and tachycardia were confined mostly to GA patients treated with chloral hydrate. Patients undergoing all forms of sedation lost an average 0.003 kg during the procedures. The researchers also found that CS took longer to complete (median 30 m) than GA (median 10 m).
"With GA, 75% of the patients completed treatment within 15 minutes, whereas when we used conscious sedation, we needed 50 minutes to complete 75% of the group," he said. Largely as a result of the time difference, the initial preference for CS over GA was reversed during the study.
"At the beginning it wasn't clear, but now as a general practice we use general anesthesia for patients who undergo radiation treatment," he said. "With regard to the ability to return the patient to a state in which safe discharge is possible, you need a skilled team, and general anesthesia saves machine and operator time."
In an effort to reduce the need for sedation, the researchers also used the results to improve patient education procedures.
By Eric BarnesAuntMinnie.com staff writer
December 8, 2000
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Tracking of pediatric sedation for MR imaging highlights concerns, July 2000
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