title: Sedation for pediatric radiological procedures: analysis of potential causes of sedation failure and paradoxical reactions.
abstract: BACKGROUND
  Sedation for diagnostic imaging and interventional radiologic procedures in pediatrics has greatly increased over the past decade. With appropriate patient selection and monitoring, serious adverse effects are infrequent, but failure to sedate and paradoxical reactions do occur.
  
  
  OBJECTIVE
  The purpose of this study was to determine, among patients undergoing sedation for radiologic procedures, the incidence of sedation failure and paradoxical reaction to pentobarbital and to identify potentially correctable causes.
  
  
  METHODS
  Records of 1665 patients who were sedated in the radiology department from 1 November 1997 to 1 July 1998 were reviewed. Patients failing sedation or experiencing paradoxical reaction were compared with respect to sex, age group, diagnosis, scan type, time of day, NPO status, use of IV contrast and type of sedation agent using the Fisher exact test, Pearson chi-square, analysis of variance (ANOVA), the Student t-test, and logistic regression.
  
  
  RESULTS
  Data analysis revealed a sedation failure rate of 1 % and paradoxical reaction rate of 1.2 %. Stepwise multiple logistic regression revealed that the only significant independent multivariate predictor of failure was the need for the administration of a combination of pentobarbital, fentanyl, and midazolam IV.
  
  
  CONCLUSIONS
  The low rate of sedation failure and paradoxical reactions to pentobarbital was near optimal and probably cannot be improved with the currently available sedatives.
authors.affiliation: Department of Radiology, Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
authors.forename: V E
authors.initials: VE
authors.lastname: Karian
authors.forename: P E
authors.initials: PE
authors.lastname: Burrows
authors.forename: D
authors.initials: D
authors.lastname: Zurakowski
authors.forename: L
authors.initials: L
authors.lastname: Connor
authors.forename: K P
authors.initials: KP
authors.lastname: Mason
mesh_terms: D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation / Q000009:adverse effects / Q000379:methods; D016208:Databases, Factual; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects; D015994:Incidence; D007223:Infant; D008297:Male; D011446:Prospective Studies; D011872:Radiology Department, Hospital; D015642:Radiology, Interventional
chemical_list: D006993:Hypnotics and Sedatives