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Mixed Pentobarbital Regimen Less Likely to Cause Complications Than Propofol in Paediatric Cardiac Patients: Presented at ASA
By Lexa W. Lee
NEW ORLEANS -- October 20, 2009 -- The incidence of complications during deep sedation for paediatric cardiac magnetic resonance imaging (MRI) decreases when a mixed regimen with intravenous pentobarbital is given versus a propofol infusion.
In addition, the incidence of complications is lower when the mixed regimen is administered by experienced paediatric cardiac anaesthesiologists, according to Solina Tith, Oregon Health & Science University, Portland, Oregon. The study was presented here on October 17 at the 2009 Annual Meeting of the American Society of Anesthesologists (ASA).
The researchers reviewed records for 179 children deeply sedated for cardiac MRI between 1998 and 2008. Incidence and complications were evaluated using the Sedation Continuous Quality Improvement (CQI) assessment. The study also identified predictors for complications.
There were 91 male patients and 88 female patients. Mean age was 5.9 years, mean weight was 21.7 kg, and mean sedation time 116.1 minutes.
Of the patients, 55 (30.7%) received the mixed regimen consisting of midazolam premedication, pentobarbital 2 to 4 mg/kg, followed by propofol 0.5 to 1 mg/kg propofol, and 124 (69.3%) received premedication, 2 to 4 mg/kg of propofol induction, and 125 to 200 mcg/kg/min of propofol infusion.
The mean pentobarbital bolus was 3.4 mg/kg and the mean propofol bolus was 4.6 mg/kg. There were complications in 33 (18.0%) of 183 sedations, of which 7 (3.8%) were major complications, compared with noncardiac MRI patients (P < .001). Complications included hypotension, aborted procedures, unplanned intubations, and an unplanned ward admission.
There was a lower incidence of complications when experienced paediatric cardiac anaesthesiologists rather than noncardiac paediatric anaesthesiologists administered the sedation.
[Presentation title: Incidence of Complications Using Two Methods of Deep Sedation for Cardiac MRI in Pediatric Patients. Abstract A628]
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