347 PREMEDICATION-AN UNAPPRECIATED RISK OF CT SCANS IN CHILDREN

Abstract

Although consideration of risks associated with CT scans generally focuses on the effects of radiation and contrast agents, we have identified premedication as an additional risk among infants and children who undergo CT scans. As part of an intensive Pediatric Drug Surveillance (PeDS) Program, we evaluated adverse drug reactions (ADR) attributed to medications given prior to CT scanning to sedate 100 infants and children (ages 2 days to 16 yrs). ADR's attributed to premedication were observed in 12 patients (12%); 6 were of major severity, 4 were moderate and 2 were minor. Life-threatening cardio-respiratory depression/arrest occurred in 3 patients after meperidine, meperidine plus diazepam and morphine. Other reactions were CNS depression, behavior changes, voiding problems, respiratory compromise and vomiting. Premedications implicated were morphine, meperidine, promethazine, chlorpromazine, chloral hydrate and diazepam. The risk of an ADR was not materially affected by admission diagnosis or prior receipt of CNS depressants, but ADR risk was increased among older patients (5+ yrs.), when > 3 premedications were used and when doses were higher than recommended. These observations suggest that ADR's to premedications must be considered when assessing the risk of CT scans in children, and that greater attention be paid to developing appropriate CT scan premedication regimens.