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Moderate sedation for MRI in young children with autism

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Abstract

Autism is a pervasive neurodevelopmental disorder. Because of the deficits associated with the condition, sedation of children with autism has been considered more challenging than sedation of other children. Objective: To test this hypothesis, we compared children with autism against clinical controls to determine differences in requirements for moderate sedation for MRI. Materials and methods: Children ages 18–36 months with autism (group 1, n = 41) and children with no autistic behavior (group 2, n = 42) were sedated with a combination of pentobarbital and fentanyl per sedation service protocol. The sedation nurse was consistent for all patients, and all were sedated to achieve a Modified Ramsay Score of 4. Demographics and doses of sedatives were recorded and compared. Results: There were no sedation failures in either group. Children in group 1 (autism) were significantly older than group 2 (32.02±3.6 months vs 28.16±6.7 months) and weighed significantly more (14.87±2.1 kg vs 13.42±2.2 kg). When compared on a per-kilogram basis, however, group 1 had a significantly lower fentanyl requirement than group 2 (1.25±0.55 mcg/kg vs 1.57±0.81 mcg/kg), but no significant difference was found in pentobarbital dosing between groups 1 and 2, respectively (4.92±0.92 mg/kg vs 5.21±1.6 mg/kg). Conclusion: Autistic children in this age range are not more difficult to sedate and do not require higher doses of sedative agents for noninvasive imaging studies.

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References

  1. American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th edn. DSM-IV, Washington, DC

  2. Mehta UC, Patel I, Castello FV (1994) EEG sedation for children with autism. Dev Behav Ped 25:102–104

    Google Scholar 

  3. Van der Walt JH, Moran C (2001) An audit of perioperative management of autistic children. Paediatr Anaesth 11:401–408

    Article  CAS  PubMed  Google Scholar 

  4. Davila JM, Jensen OE (1988) Behavioral and pharmacological dental management of a patient with autism. Spec Care Dent 8:58–60

    CAS  Google Scholar 

  5. Rumm PD, Takato RT, Fox DJ, et al (1990) Efficacy of sedation of children with chloral hydrate. South Med J 83:1040–1043

    CAS  PubMed  Google Scholar 

  6. Lord C, Rutter M, LeCouteur A (1994) Autism diagnostic interview-revised: a revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. J Autism Dev Disord 24:659–685

    CAS  PubMed  Google Scholar 

  7. Lord C, Rutter M, Goude S, et al (1989) Autism diagnostic observation scale: a standardized observation of communicative and social behavior. J Autism Dev Disord 19:185–212

    CAS  PubMed  Google Scholar 

  8. Rainey L, van der Walt JH (1998) The anaesthetic management of autistic children. Anaesth Intensive Care 26:682–686

    CAS  PubMed  Google Scholar 

  9. Seid M, Sherman M, Seid AB (1997) Perioperative psychosocial interventions for autistic children undergoing ENT surgery. Int J Pediatr Otorhinolaryngol 40:107–113

    Article  CAS  PubMed  Google Scholar 

  10. Kopel HM (1977) The autistic child in dental practice. J Dent Child 44:302–309

    CAS  Google Scholar 

  11. Braff MH, Nealon L (1979) Sedation of the autistic patient for dental procedures. J Dent Child 46:404–407

    CAS  Google Scholar 

  12. Klein U, Nowak AJ (1999) Characteristics of patients with autistic disorder (AD) presenting for dental treatment: a survey and chart review. Spec Care Dent 19:200–207

    CAS  Google Scholar 

  13. Gutstein HB, Johnson KL, Heard MB, et al (1992) Oral ketamine preanesthetic medication in children. Anesthesiology 76:28–33

    CAS  PubMed  Google Scholar 

  14. Donahue PJ, Dineen PS (1992) Emergence delirium following oral ketamine. Anesthesiology 77:604–605

    CAS  PubMed  Google Scholar 

  15. Strain JD, Campbell JB, Harvey LA, et al (1988) IV Nembutal: safe sedation for children undergoing CT. AJR 151:975–979

    CAS  PubMed  Google Scholar 

  16. Frush D, Bissett G, Hall S (1996) Pediatric sedation in radiology: the practice of safe sleep. AJR 167:1381–1387

    CAS  PubMed  Google Scholar 

  17. Mason KP, Zurakowski D, Karian VE, et al (2001) Sedatives used in pediatric imaging: comparison of IV pentobarbital with IV pentobarbital with midazolam added. AJR 177:427–430

    CAS  PubMed  Google Scholar 

  18. Karian VE, Burrows PE, Zurakowski D, et al (1999) Sedation for pediatric radiologic procedures: analysis of potential causes of sedation failure and paradoxical reactions. Pediatr Radiol 29:869–873

    Article  CAS  PubMed  Google Scholar 

  19. Karian VE, Burrows PE, Zukarowski D, et al (2002) The development of a pediatric radiology sedation program. Pediatr Radiol 32:348–353

    Article  PubMed  Google Scholar 

  20. Malviya S, Voepel-Lewis T, Tait AR, et al (2004) Pentobarbital versus chloral hydrate for sedation of children undergoing MRI: efficacy and recovery characteristics. Paediatr Anaesth 14:589–595

    Article  PubMed  Google Scholar 

  21. Connor L, Burrows PE, Zurakowski D, et al (2003) Effects of IV pentobarbital with and without fentanyl on end-tidal carbon dioxide levels during deep sedation of pediatric patients undergoing MRI. AJR 181:1601–1694

    Google Scholar 

  22. American Academy of Pediatric Committee on Drugs (1992) Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures. Pediatrics 89:1110–1115

    PubMed  Google Scholar 

  23. Hoffman GM, Nowakowski R, Troshynski TJ, et al (2002) Risk reduction in pediatric procedural sedation by application of an American Academy of Pediatrics/American Society of Anesthesiologists process model. Pediatrics 109:236–243

    Article  PubMed  Google Scholar 

  24. Cote CJ, Notterman DA, Karl HW, et al (2000) Adverse sedation events in pediatrics: a critical incident analysis of contributing factors. Pediatrics 105:805–814

    Article  CAS  PubMed  Google Scholar 

  25. Cravero JP, Blike GT (2004) Review of pediatric sedation. Anesth Analg 99:1355–1364

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors would like to recognize Michele Poe, PhD, for her statistical support on this project, as well as all members of the Autism Research Group. Research supported by NIH Grant MH61696 (J. Piven) and NIH MRDDRC Grant 5 P30 HD03110 (J. Piven).

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Correspondence to Allison Kinder Ross.

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Ross, A.K., Hazlett, H.C., Garrett, N.T. et al. Moderate sedation for MRI in young children with autism. Pediatr Radiol 35, 867–871 (2005). https://doi.org/10.1007/s00247-005-1499-2

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  • DOI: https://doi.org/10.1007/s00247-005-1499-2

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