Background Elective MRI scans require a child to stay still, which is often achieved with either oral sedation or a general anaesthetic in a young child or those with cognitive or behavioural difficulties.
There is limited provision for use of general anaesthetic for elective MRIs within our DGH and majority of elective neuroimaging is done using oral sedation. The local protocol uses combination of Alimemazine Tartrate and Chloral Hydrate to achieve sedation in young children.
Objectives A service review was undertaken to assess effectiveness of oral sedation, complications and achievement of high quality MRI images.
Methods Elective appointments at paediatric day unit were evaluated retrospectively for 12 months from March 2019 to February 2020 (before the Covid-19 pandemic affected local services).
Data was analysed for 64 patients from electronic health records to look for effectiveness of sedation and outcomes.
Data was not evaluated for 8 children who were not brought for their appointment, 1 child who was not adequately fasted and 3 children who attended late so missed their MRI slot.
Majority (80%) of planned imaging was for Brain relating to epilepsy or other neurodevelopmental disorders; other scans were booked for spine, ears or hips.
Results 67.2% children were successfully sedated and completed MRI scans (43/64).
Failure of sedation was 44% in older children (11/25) compared to 25.6% of those under 4 years age (10/39).
2 children vomited and 1 refused the oral medication.
18 children were not adequately sedated, of which 12 were re-booked for imaging with oral sedation and others booked for MRI under general anaesthetic.
2 patients also received oral Midazolam, of which 1 achieved successful MRI.
18.6% of MRIs (8/43) were reported as poor quality or had movement artefacts, suggesting achievement of good quality imaging in 54.6% planned elective MRIs (35/64).
There were no major complications but 2 children had low oxygen saturations related to deep sedation during scan; of which 1 child was kept overnight due to desaturations.
Conclusions Oral sedation using combination of Alimemazine Tartrate and Chloral Hydrate is safe within district general hospitals where provision of general anaesthetic is limited.
The partially successful sedation is also reported by other centres, leading to poor utilisation of MRI slots.
Inadequate sedation further impacts the quality of neuro-imaging affecting diagnostic yield in potentially significant underlying neurodevelopmental disorders.
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