Development of a nurse-led sedation service for paediatric magnetic resonance imaging

Background Children generally lie still enough for magnetic resonance imagi ng (MRI) only if they are asleep, either under sedation, which is deeper th an conscious sedation, or under anaesthesia. Anaesthesia resources, however , are limited, and non-anaesthetists must use sedation frequently. Demand f or MRI has increased and the failure of our sedation regimen led to an impr actical demand for anaesthesia and unacceptable waiting times for scanning. We have therefore developed a nurse-led sedation service in a designated u nit next to the scanner. This study assessed the safety and efficacy of thi s approach. Methods Children who required MRI were sedated in the unit by designated se dationist nurses, who used an oral drug regimen (according to weight and ag e from conception: weight <5 hg, 50 mg/kg chloral hydrate; 5-10 kg, 100 mg/ hg chloral hydrate; 10-20 hg, 1 mg/kg temazepam plus 0.25 mg/kg droperidol; >20 kg temazepam and droperidol as directed by radiologist; maximum doses 20 mg and 5 mg respectively). Nurses checked patients for their suitability , charted and administered the drugs according to a protocol, and monitored the children throughout the sedation. We prospectively audited failure and complications of sedation. Findings During the 30 month study, there were 1155 sedations. 61 (5%) were unsuccessful, and there were no adverse events relating to the airway or b reathing. After scanning had finished all children, in response to gently p inching the nose, could open their mouths to maintain their airway. Interpretation This study suggests that it is possible to have a nurse-led sedation service for MRI of children that is both successful and safe.