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Conscious Sedation for the Neonate needing MRI/CT scanning

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on 28 November 2012

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Transcript of Conscious Sedation for the Neonate needing MRI/CT scanning

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 Conscious Sedation for the
Neonate needing MRI or CT Scanning Morphine
Fentanyl Opioids Analgesia but no sedation Midazolam
Lorazepam Benzodiazepines 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. Phenobarbital
Pentobarbital Barbiturates 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) Pros: well tolerated and 80-90% of infants achieve adequate sedation Chloral hydrate 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. Dosing Options 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 Old drug, but still the drug of choice when sedation for non-painful procedures is needed
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