Rectal methohexital sedation for computed tomography imaging of stable pediatric emergency department patients

Objective. Rapid onset of sleep, brief duration of action, and ease of admi nistration are properties that make rectal methohexital (MXT) an attractive choice for sedating stable pediatric emergency department (ED) patients fo r computed tomography (CT) imaging. Methodology. One hundred stable patients between 3 and 60 months of age who presented to any of 3 participating EDs and required sedation to undergo C T scanning were given 25 mg/kg of rectal MXT similar to 15 minutes before t heir imaging. Vital signs and oxygen saturation were recorded at regular in tervals. Data collected included indication for CT imaging, time to achieve sleep, time to reach discharge criteria, adequacy of sedation, adverse eff ects, and parental satisfaction. Results. Ninety-five percent of the patients were adequately sedated with r ectal MXT. It took an average of 8 minutes to achieve full sedation and the duration of action averaged 79.3 minutes. Ten percent had transient side e ffects, but all recovered completely. None required intubation. Parental sa tisfaction was 90%. Conclusion. Rectal MXT compares favorably to other methods of nonintravenou s sedation for CT scanning of stable pediatric ED patients in terms of rapi dity of onset and reliability but does cause a significant amount of transi ent respiratory depression. Its use requires careful monitoring of oxygen s aturation and should be used only in a setting where physicians skilled in airway management are present. If these requirements are met, it may be a g ood choice for the relatively noninvasive sedation of pediatric ED patients undergoing painless but anxiety-provoking procedures.