Inadequate sedation leads to both cancellation of studies or poor images due to motion artifact.
delay in diagnosis or treatment
nursing time away from the unit
slows work flow in the MRI/CT suite
Analgesia but no sedation
Often used for sedation or seizure control but are associated with apnea and hypotension.
Associated with increased risk of death, severe IVH, PVL and poor neurodevelopmental outcomes in general.
side effects include respiratory depression, hypotension, tolerance and dependence.
Lifelong suppression of hippocampal synaptic plasticity when given during synaptogenesis in rat studies. (affecting LTP and learning ability)
Old drug, but still the drug of choice when sedation for non-painful procedures is needed
Pros: well tolerated and 80-90% of infants achieve adequate sedation
Cons: variable time to work, leaves babies drowsy for unpredictably long periods of time, and... there is no antidote.
50 mg/kg initial dose. If sedation is not adequate in 30-60 minutes, an additional 50 mg/kg may be given
75 mg/kg is more typical with a maximum of 100 mg/kg.
Dose may be given PO or per rectum
May be given 30 minutes to an hour before the procedure. Or even longer!
Feeding and swaddling are always helpful
Conscious Sedation for the
Neonate needing MRI or CT Scanning
Dosing Options
Chloral hydrate
Opioids
Morphine
Fentanyl
Benzodiazepines
Midazolam
Lorazepam
Barbiturates
Phenobarbital
Pentobarbital