title: Evaluation of adult outpatient magnetic resonance imaging sedation practices: are patients being sedated optimally?
abstract: OBJECTIVE
  To evaluate the use of anxiolytics in adult outpatient magnetic resonance imaging (MRI) centres and to determine whether utilisation is optimal based on the pharmacology of the drugs used, who prescribes these drugs, and how patients are managed after administration.
  
  
  METHODS
  Identical paper and Web-based surveys were used to anonymously collect data about radiologists' use of anxiolytic agents for adult outpatient MRI examinations. The survey questions were about the type of facility, percentage of studies that require sedation, the drug used and route of administration, who orders the drug, timing of administration, patient monitoring during and observation after the study, use of a dedicated nurse for monitoring, and use of standard sedation and discharge protocols. The chi(2) analysis for statistical association among variables was used.
  
  
  RESULTS
  Eighty-five of 263 surveys were returned (32% response rate). The radiologist ordered the medication (53%) in slightly more facilities than the referring physician (44%) or the nurse. Forty percent of patients received medication 15-30 minutes before MRI, which is too early for peak effect of oral or sublingual drugs. Lorazepam was most commonly used (64% first choice). Facilities with standard sedation protocols (56%) were more likely to use midazolam than those without standard sedation protocols (17% vs 10%), to have a nurse for monitoring (P = .032), to have standard discharge criteria (P = .001), and to provide written information regarding adverse effects (P = .002).
  
  
  CONCLUSIONS
  Many outpatients in MRI centres may be scanned before the peak effect of anxiolytics prescribed. A standard sedation protocol in such centres is associated with a more appropriate drug choice, as well as optimized monitoring and postprocedure care.
authors.affiliation: University of British Columbia Diagnostic Radiology Residency Program, Vancouver, British Columbia, Canada.
authors.forename: Janel E
authors.initials: JE
authors.lastname: Middelkamp
authors.forename: Bruce B
authors.initials: BB
authors.lastname: Forster
authors.forename: Ciaran
authors.initials: C
authors.lastname: Keogh
authors.forename: Pamela
authors.initials: P
authors.lastname: Lennox
authors.forename: Kelly
authors.initials: K
authors.lastname: Mayson
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D014151:Anti-Anxiety Agents / Q000008:administration & dosage*; D016292:Procedural Sedation; D003625:Data Collection; D003975:Diazepam / Q000008:administration & dosage; D004363:Drug Utilization; D006801:Humans; D008140:Lorazepam / Q000008:administration & dosage; D008279:Magnetic Resonance Imaging; D008874:Midazolam / Q000008:administration & dosage
chemical_list: D014151:Anti-Anxiety Agents; D008140:Lorazepam; D003975:Diazepam; D008874:Midazolam