SEDATION FAILURES IN CHILDREN UNDERGOING MRI AND CT

Abstract

S312 INTRODUCTION: Sedation of children for magnetic resonance imaging (MRI) and computerized tomography (CT) frequently fails to produce the cooperation necessary to complete the test. Indeed, previous studies reported a 5-15% incidence of failed sedation that, in many cases, resulted in rescheduling the procedure with general anesthesia [1,2]. We recently reported that children whose sedation failed were older and more likely to have received combinations of drugs compared to children with adequate sedation [1]. Furthermore, other studies suggest that certain aspects of temperament are related to the sedated child's behavior during dental treatment [3]. The purpose of this prospective study was to determine whether underlying temperament is related to sedation failures in MRI and CT. METHODS: With IRB approval and parental consent, children aged 3-7 years scheduled to undergo sedation for MRI or CT were studied. Parents completed the Behavioral Style Questionnaire for 3-7 year olds, a valid and reliable tool that produces numerical values [1 (low/positive) to 6 (high/negative)] for 9 dimensions of temperament [4]. From these scores, temperament is grouped into a diagnostic cluster: easy, slow to warm up, or difficult. Nurses caring for the child recorded medications given, level of sedation, adverse events including adequacy of sedation and sedation failures (necessitating rescheduling). Data were analyzed using unpaired t-tests, and p <0.05 was considered significant. RESULTS: To date, 52 children (4.5 +/- 1.4 yrs; 57%male, 43%female; 80% ASA I, 20% ASA II) have been studied. Forty-five (87%) received chloral hydrate (CH) as a sole sedative, 6 (12%) received CH plus a benzodiazepine, and 1 (2%) received only a benzodiazepine. There were 8 (15%) cases of failed sedation; two that were rescheduled for sedation, and 6 for general anesthesia. Table 1 presents the temperament scores of each group. Children whose sedation failed were more likely to be non-adaptable (p = 0.02) and have negative moods (p=0.04) compared to those whose sedation was successful. Additionally, 25% of children with failed sedation had "difficult" temperaments compared to only 7% of those whose sedation was successful (p = 0.04).Table 1: Temperament Scores (mean +/- SD).DISCUSSION: Our preliminary data suggests that a child's underlying temperament may be related to his/her response to sedation for MRI or CT. Specifically, children who are less adaptable to new situations, those with negative moods, and those who are generally difficult may be more likely to experience failed sedation. These results are similar to those of Lochary et al. who reported that adaptability was predictive of sedation behavior, however they also found approachability to be a factor [4]. It is hoped that these data may be of interest in determining appropriate interventions to facilitate MRI and CT.