title: Chest CT in children: anesthesia and atelectasis.
abstract: BACKGROUND
  There has been an increasing tendency for anesthesiologists to be responsible for providing sedation or anesthesia during chest CT imaging in young children. Anesthesia-related atelectasis noted on chest CT imaging has proven to be a common and troublesome problem, affecting image quality and diagnostic sensitivity.
  
  
  OBJECTIVE
  To evaluate the safety and effectiveness of a standardized anesthesia, lung recruitment, controlled-ventilation technique developed at our institution to prevent atelectasis for chest CT imaging in young children.
  
  
  METHODS
  Fifty-six chest CT scans were obtained in 42 children using a research-based intubation, lung recruitment and controlled-ventilation CT scanning protocol. These studies were compared with 70 non-protocolized chest CT scans under anesthesia taken from 18 of the same children, who were tested at different times, without the specific lung recruitment and controlled-ventilation technique. Two radiology readers scored all inspiratory chest CT scans for overall CT quality and atelectasis. Detailed cardiorespiratory parameters were evaluated at baseline, and during recruitment and inspiratory imaging on 21 controlled-ventilation cases and 8 control cases.
  
  
  RESULTS
  Significant differences were noted between groups for both quality and atelectasis scores with optimal scoring demonstrated in the controlled-ventilation cases where 70% were rated very good to excellent quality scans compared with only 24% of non-protocol cases. There was no or minimal atelectasis in 48% of the controlled ventilation cases compared to 51% of non-protocol cases with segmental, multisegmental or lobar atelectasis present. No significant difference in cardiorespiratory parameters was found between controlled ventilation and other chest CT cases and no procedure-related adverse events occurred.
  
  
  CONCLUSIONS
  Controlled-ventilation infant CT scanning under general anesthesia, utilizing intubation and recruitment maneuvers followed by chest CT scans, appears to be a safe and effective method to obtain reliable and reproducible high-quality, motion-free chest CT images in children.
authors.affiliation: Department of Radiology, Lucile Packard Children's Hospital, 725 Welch Road, MC 5913, Stanford, CA, 94305, USA, bevn@stanford.edu.
authors.forename: Beverley
authors.initials: B
authors.lastname: Newman
authors.forename: Elliot J
authors.initials: EJ
authors.lastname: Krane
authors.forename: Rakhee
authors.initials: R
authors.lastname: Gawande
authors.forename: Tyson H
authors.initials: TH
authors.lastname: Holmes
authors.forename: Terry E
authors.initials: TE
authors.lastname: Robinson
mesh_terms: D018681:Anesthetics, General / Q000009:adverse effects*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D001261:Pulmonary Atelectasis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000517:prevention & control*; D013902:Radiography, Thoracic / Q000187:drug effects* / Q000379:methods*; D015203:Reproducibility of Results; D012121:Respiration, Artificial / Q000379:methods*; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D018681:Anesthetics, General