Pentobarbital vs chloral hydrate for sedation of children undergoing MRI: Efficacy and recovery characteristics

Shobha Malviya, Terri Voepel-Lewis, Alan R. Tait, Paul I. Reynolds, Sachin K Gujar, Stephen S. Gebarski, O. Petter Eldevik

Research output: Contribution to journalArticle

Abstract

Background: Chloral hydrate (CH) sedation for magnetic resonance imaging (MRI) is associated with significant failure rates, adverse events and delayed recovery. Pentobarbital (PB), reportedly produces successful sedation in 98% of children undergoing diagnostic imaging. This study compared the efficacy, adverse events and recovery characteristics of CH vs PB in children undergoing MRI. Methods: With Institutional Review Board approval and written consent, children were randomly assigned to receive intravenous (i.v.) PB (maximum 5 mg·kg-1 in incremental doses) or oral CH (75 mg·kg -1) prior to MRI. Sedation was augmented with 0.05 mg·kg -1 doses of i.v. midazolam (maximum 0.1 mg·kg-1) as necessary. Adverse effects, including hypoxaemia, failed sedation, paradoxical reactions and behavioural changes, the return of baseline activity, and parental satisfaction were documented. The quality of MRI scans was evaluated by a radiologist blinded to the sedation technique. Results: PB facilitated an earlier onset of sedation (P = 0.001), higher sedation scores (P = 0.01), and less need for supplemental midazolam compared with CH. Severe hypoxaemia occurred in two children (6%) in the PB group. Fourteen per cent of the PB group experienced a paradoxical reaction, 9% sedation failure and 11% major motion artefact, compared with 0% (P = 0.05), 3 and 2% (P = NS), respectively, in the CH group. CH and PB were both associated with a high incidence of motor imbalance, and agitation. However, children who received PB had a slower return to baseline activity (P = 0.04). Conclusions: Although PB facilitated a quicker sedation onset and reduced the requirement for supplemental sedation, it produced a higher incidence of paradoxical reaction and prolonged recovery with a similar failure rate compared with CH.

Original languageEnglish (US)
Pages (from-to)589-595
Number of pages7
JournalPaediatric Anaesthesia
Volume14
Issue number7
DOIs
StatePublished - 2004
Externally publishedYes

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Chloral Hydrate
Pentobarbital
Magnetic Resonance Imaging
Midazolam
Research Ethics Committees
Incidence
Diagnostic Imaging
Artifacts

Keywords

  • Chloral hydrate
  • Magnetic resonance imaging
  • Sedation: Pentobarbital

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Pediatrics, Perinatology, and Child Health

Cite this

Pentobarbital vs chloral hydrate for sedation of children undergoing MRI : Efficacy and recovery characteristics. / Malviya, Shobha; Voepel-Lewis, Terri; Tait, Alan R.; Reynolds, Paul I.; Gujar, Sachin K; Gebarski, Stephen S.; Eldevik, O. Petter.

In: Paediatric Anaesthesia, Vol. 14, No. 7, 2004, p. 589-595.

Research output: Contribution to journalArticle

Malviya, Shobha ; Voepel-Lewis, Terri ; Tait, Alan R. ; Reynolds, Paul I. ; Gujar, Sachin K ; Gebarski, Stephen S. ; Eldevik, O. Petter. / Pentobarbital vs chloral hydrate for sedation of children undergoing MRI : Efficacy and recovery characteristics. In: Paediatric Anaesthesia. 2004 ; Vol. 14, No. 7. pp. 589-595.
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abstract = "Background: Chloral hydrate (CH) sedation for magnetic resonance imaging (MRI) is associated with significant failure rates, adverse events and delayed recovery. Pentobarbital (PB), reportedly produces successful sedation in 98{\%} of children undergoing diagnostic imaging. This study compared the efficacy, adverse events and recovery characteristics of CH vs PB in children undergoing MRI. Methods: With Institutional Review Board approval and written consent, children were randomly assigned to receive intravenous (i.v.) PB (maximum 5 mg·kg-1 in incremental doses) or oral CH (75 mg·kg -1) prior to MRI. Sedation was augmented with 0.05 mg·kg -1 doses of i.v. midazolam (maximum 0.1 mg·kg-1) as necessary. Adverse effects, including hypoxaemia, failed sedation, paradoxical reactions and behavioural changes, the return of baseline activity, and parental satisfaction were documented. The quality of MRI scans was evaluated by a radiologist blinded to the sedation technique. Results: PB facilitated an earlier onset of sedation (P = 0.001), higher sedation scores (P = 0.01), and less need for supplemental midazolam compared with CH. Severe hypoxaemia occurred in two children (6{\%}) in the PB group. Fourteen per cent of the PB group experienced a paradoxical reaction, 9{\%} sedation failure and 11{\%} major motion artefact, compared with 0{\%} (P = 0.05), 3 and 2{\%} (P = NS), respectively, in the CH group. CH and PB were both associated with a high incidence of motor imbalance, and agitation. However, children who received PB had a slower return to baseline activity (P = 0.04). Conclusions: Although PB facilitated a quicker sedation onset and reduced the requirement for supplemental sedation, it produced a higher incidence of paradoxical reaction and prolonged recovery with a similar failure rate compared with CH.",
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T1 - Pentobarbital vs chloral hydrate for sedation of children undergoing MRI

T2 - Efficacy and recovery characteristics

AU - Malviya, Shobha

AU - Voepel-Lewis, Terri

AU - Tait, Alan R.

AU - Reynolds, Paul I.

AU - Gujar, Sachin K

AU - Gebarski, Stephen S.

AU - Eldevik, O. Petter

PY - 2004

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AB - Background: Chloral hydrate (CH) sedation for magnetic resonance imaging (MRI) is associated with significant failure rates, adverse events and delayed recovery. Pentobarbital (PB), reportedly produces successful sedation in 98% of children undergoing diagnostic imaging. This study compared the efficacy, adverse events and recovery characteristics of CH vs PB in children undergoing MRI. Methods: With Institutional Review Board approval and written consent, children were randomly assigned to receive intravenous (i.v.) PB (maximum 5 mg·kg-1 in incremental doses) or oral CH (75 mg·kg -1) prior to MRI. Sedation was augmented with 0.05 mg·kg -1 doses of i.v. midazolam (maximum 0.1 mg·kg-1) as necessary. Adverse effects, including hypoxaemia, failed sedation, paradoxical reactions and behavioural changes, the return of baseline activity, and parental satisfaction were documented. The quality of MRI scans was evaluated by a radiologist blinded to the sedation technique. Results: PB facilitated an earlier onset of sedation (P = 0.001), higher sedation scores (P = 0.01), and less need for supplemental midazolam compared with CH. Severe hypoxaemia occurred in two children (6%) in the PB group. Fourteen per cent of the PB group experienced a paradoxical reaction, 9% sedation failure and 11% major motion artefact, compared with 0% (P = 0.05), 3 and 2% (P = NS), respectively, in the CH group. CH and PB were both associated with a high incidence of motor imbalance, and agitation. However, children who received PB had a slower return to baseline activity (P = 0.04). Conclusions: Although PB facilitated a quicker sedation onset and reduced the requirement for supplemental sedation, it produced a higher incidence of paradoxical reaction and prolonged recovery with a similar failure rate compared with CH.

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