1. Sedation of Patients for Nuclear Medicine and Radiographic Procedures Susan Weiss, CNMT Radiation Safety Officer The Children’s Memorial Medical Center Chicago, IL

2. Patient cooperation factors Age Fear Comprehension Expectations Sedation

3. Sedation Required 1-3 years Bone imaging SPECT Mental Retardation

4. Issues Inadequate Monitoring Inappropriate dosage Lack of evaluation No CPR training No discharge criteria

5. Sedation Goals Patient Safety Minimize discomfort Diminish negative response Control behavior Control motion

6. Conscious Sedation A medically controlled state of depressed consciousness that: 1) allows protective reflexes to be maintained 2) retains patient’s ability to maintain patent airway 3) permits appropriate response to physical stimulation.

7. Sedation Risks Hypoventilation Apnea Airway obstruction Cardiopulmonary arrest

8. Facilities and Equipment Oxygen delivery system Suction apparatus Sphygmomanometer and cuffs Pulse oximeter Emergency cart –Drugs –Airways –Breathing equipment

9. Sedation Benefits Cooperation Limit Motion Minimize Discomfort

10. Informed Consent Prior Notification Parent or Legal Guardian Documented

11. Informed Consent Oral Written Care post-discharge

12. Health Evaluation Health Hx Review of systems Vital signs Physical exam Physical status evaluation Weight Documented

13. Health History Allergies Drug use Diseases Pregnancy Hospitalization Sedation Hx Family Hx

14. Physical Status Evaluation ASA Classification Class I Normal healthy patient Class II Mild systemic disease Class III Severe systemic disease Class IV Severe systemic disease- constant life threatening Class V Moribund patient who will not survive without procedure

15. Pre-Sedation Dietary Restrictions 0-5 Months No milk or solids 4 hours prior 6-36 Months No milk or solids 6 hours prior 36+ monthsNo milk or solids 8 hours prior All agesClear liquids until 2 hours prior

16. Sedative Agents Benzodiazepines –Valium –Versed Barbiturates –Nembutal Opiates –Demerol –Fentanyl

17. Sedative Agents Phenothiazines Antihistamines Neuroleptics

18. Sedation Chloral Hydrate, 50 mg/kg Repeat 1/2 dose

19. Midazolam Initial dose = 0.2-0.3 mg/kg Maximum = 5 mg Supplementary dose = 0.1 mg/kg Maximum = 2.5 mg

20. Designated Observer CPR trained M.D., R.N., C.N.M.T. Primary responsibility Not imaging technologist Documents sedation and monitoring

21. Discharge Criteria Airway patency Stable cardiovascular function Intact protective reflexes Easy arousability Responding appropriately Sits unaided Adequately hydrated

22. Discharge Instructions Observation and Monitoring Dietary restrictions 24 hour emergency number

23. Documentation Informed consent Health evaluation Sedation plan Administration of sedative Monitoring Discharge evaluation Post discharge instructions

24. Quality Assurance Develop policies Formulary QA Committee Monitoring Education