Etomidate versus pentobarbital for sedation of children for head and neck CT imaging

Andrew J. Kienstra, Mark A. Ward, Fahimeh Sasan, Jill Hunter, M. Craig Morriss, Charles G. Macias

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Objectives: We compare etomidate to pentobarbital for sedation of children for head and neck computed tomography imaging. Methods: We performed a prospective, randomized, double-blinded trial of patients aged 6 months to 6 years enrolled from the emergency department or radiology department at a large urban children's hospital. The primary outcome measure was sedation success rate. Results: A total of 61 patients were enrolled in the study (27 etomidate group, 34 pentobarbital group) at 2 different dosing regimens for etomidate. The final analysis group included 17 etomidate patients and 33 pentobarbital patients. The success rate for the etomidate group was 57% at total doses of up to 0.3 mg/kg (n = 7) and 76% at total doses of up to 0.4 mg/kg (n = 17), in contrast to a success rate of 97% for pentobarbital at a total dose of up to 5 mg/kg (n = 33). The success rate for pentobarbital was significantly greater than the final etomidate group (P = 0.04; difference in proportions 20.5%, 95% CI 1.9% to 44.4%). Patients receiving etomidate had significantly shorter induction times (P = 0.02; difference of means 2.1 minutes, 95% CI 0.35 to 3.86), sedation times (P < 0.001; difference of means 31.3 minutes, 95% CI 24.0 to 38.5), and total examination times (P < 0.001; difference of means 53.1 minutes, 95% CI 40.8 to 65.3). Significantly more parents in the etomidate group perceived their child to be back to baseline by discharge from the hospital (P < 0.001; difference of proportions 60.7, 95% CI 29.1 to 92.4) and expressed fewer concerns about their child's behavior after discharge (P = 0.024; difference of proportions 28.6, 95% CI 6.5 to 50.7). Conclusions: At the dosing used in this study, pentobarbital is superior to etomidate when comparing success rates for sedation. However, among the successful sedations, the duration of sedation was shorter in the etomidate group than in the pentobarbital group. Pentobarbital is associated with more frequent side effects and parental concerns compared to etomidate.

Original languageEnglish (US)
Pages (from-to)499-506
Number of pages8
JournalPediatric Emergency Care
Volume20
Issue number8
DOIs
StatePublished - Aug 2004

Fingerprint

Etomidate
Pentobarbital
Neck
Head
Urban Hospitals
Child Behavior
Radiology
Hospital Emergency Service
Parents

Keywords

  • CT
  • Etomidate
  • Imaging
  • Pentobarbital
  • Sedation

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Nursing(all)
  • Emergency Medicine

Cite this

Etomidate versus pentobarbital for sedation of children for head and neck CT imaging. / Kienstra, Andrew J.; Ward, Mark A.; Sasan, Fahimeh; Hunter, Jill; Morriss, M. Craig; Macias, Charles G.

In: Pediatric Emergency Care, Vol. 20, No. 8, 08.2004, p. 499-506.

Research output: Contribution to journalArticle

Kienstra, Andrew J. ; Ward, Mark A. ; Sasan, Fahimeh ; Hunter, Jill ; Morriss, M. Craig ; Macias, Charles G. / Etomidate versus pentobarbital for sedation of children for head and neck CT imaging. In: Pediatric Emergency Care. 2004 ; Vol. 20, No. 8. pp. 499-506.
@article{1b619449a6be492caa415b7f6dee96c5,
title = "Etomidate versus pentobarbital for sedation of children for head and neck CT imaging",
abstract = "Objectives: We compare etomidate to pentobarbital for sedation of children for head and neck computed tomography imaging. Methods: We performed a prospective, randomized, double-blinded trial of patients aged 6 months to 6 years enrolled from the emergency department or radiology department at a large urban children's hospital. The primary outcome measure was sedation success rate. Results: A total of 61 patients were enrolled in the study (27 etomidate group, 34 pentobarbital group) at 2 different dosing regimens for etomidate. The final analysis group included 17 etomidate patients and 33 pentobarbital patients. The success rate for the etomidate group was 57{\%} at total doses of up to 0.3 mg/kg (n = 7) and 76{\%} at total doses of up to 0.4 mg/kg (n = 17), in contrast to a success rate of 97{\%} for pentobarbital at a total dose of up to 5 mg/kg (n = 33). The success rate for pentobarbital was significantly greater than the final etomidate group (P = 0.04; difference in proportions 20.5{\%}, 95{\%} CI 1.9{\%} to 44.4{\%}). Patients receiving etomidate had significantly shorter induction times (P = 0.02; difference of means 2.1 minutes, 95{\%} CI 0.35 to 3.86), sedation times (P < 0.001; difference of means 31.3 minutes, 95{\%} CI 24.0 to 38.5), and total examination times (P < 0.001; difference of means 53.1 minutes, 95{\%} CI 40.8 to 65.3). Significantly more parents in the etomidate group perceived their child to be back to baseline by discharge from the hospital (P < 0.001; difference of proportions 60.7, 95{\%} CI 29.1 to 92.4) and expressed fewer concerns about their child's behavior after discharge (P = 0.024; difference of proportions 28.6, 95{\%} CI 6.5 to 50.7). Conclusions: At the dosing used in this study, pentobarbital is superior to etomidate when comparing success rates for sedation. However, among the successful sedations, the duration of sedation was shorter in the etomidate group than in the pentobarbital group. Pentobarbital is associated with more frequent side effects and parental concerns compared to etomidate.",
keywords = "CT, Etomidate, Imaging, Pentobarbital, Sedation",
author = "Kienstra, {Andrew J.} and Ward, {Mark A.} and Fahimeh Sasan and Jill Hunter and Morriss, {M. Craig} and Macias, {Charles G.}",
year = "2004",
month = "8",
doi = "10.1097/01.pec.0000136065.22328.df",
language = "English (US)",
volume = "20",
pages = "499--506",
journal = "Pediatric Emergency Care",
issn = "0749-5161",
publisher = "Lippincott Williams and Wilkins",
number = "8",

}

TY - JOUR

T1 - Etomidate versus pentobarbital for sedation of children for head and neck CT imaging

AU - Kienstra, Andrew J.

AU - Ward, Mark A.

AU - Sasan, Fahimeh

AU - Hunter, Jill

AU - Morriss, M. Craig

AU - Macias, Charles G.

PY - 2004/8

Y1 - 2004/8

N2 - Objectives: We compare etomidate to pentobarbital for sedation of children for head and neck computed tomography imaging. Methods: We performed a prospective, randomized, double-blinded trial of patients aged 6 months to 6 years enrolled from the emergency department or radiology department at a large urban children's hospital. The primary outcome measure was sedation success rate. Results: A total of 61 patients were enrolled in the study (27 etomidate group, 34 pentobarbital group) at 2 different dosing regimens for etomidate. The final analysis group included 17 etomidate patients and 33 pentobarbital patients. The success rate for the etomidate group was 57% at total doses of up to 0.3 mg/kg (n = 7) and 76% at total doses of up to 0.4 mg/kg (n = 17), in contrast to a success rate of 97% for pentobarbital at a total dose of up to 5 mg/kg (n = 33). The success rate for pentobarbital was significantly greater than the final etomidate group (P = 0.04; difference in proportions 20.5%, 95% CI 1.9% to 44.4%). Patients receiving etomidate had significantly shorter induction times (P = 0.02; difference of means 2.1 minutes, 95% CI 0.35 to 3.86), sedation times (P < 0.001; difference of means 31.3 minutes, 95% CI 24.0 to 38.5), and total examination times (P < 0.001; difference of means 53.1 minutes, 95% CI 40.8 to 65.3). Significantly more parents in the etomidate group perceived their child to be back to baseline by discharge from the hospital (P < 0.001; difference of proportions 60.7, 95% CI 29.1 to 92.4) and expressed fewer concerns about their child's behavior after discharge (P = 0.024; difference of proportions 28.6, 95% CI 6.5 to 50.7). Conclusions: At the dosing used in this study, pentobarbital is superior to etomidate when comparing success rates for sedation. However, among the successful sedations, the duration of sedation was shorter in the etomidate group than in the pentobarbital group. Pentobarbital is associated with more frequent side effects and parental concerns compared to etomidate.

AB - Objectives: We compare etomidate to pentobarbital for sedation of children for head and neck computed tomography imaging. Methods: We performed a prospective, randomized, double-blinded trial of patients aged 6 months to 6 years enrolled from the emergency department or radiology department at a large urban children's hospital. The primary outcome measure was sedation success rate. Results: A total of 61 patients were enrolled in the study (27 etomidate group, 34 pentobarbital group) at 2 different dosing regimens for etomidate. The final analysis group included 17 etomidate patients and 33 pentobarbital patients. The success rate for the etomidate group was 57% at total doses of up to 0.3 mg/kg (n = 7) and 76% at total doses of up to 0.4 mg/kg (n = 17), in contrast to a success rate of 97% for pentobarbital at a total dose of up to 5 mg/kg (n = 33). The success rate for pentobarbital was significantly greater than the final etomidate group (P = 0.04; difference in proportions 20.5%, 95% CI 1.9% to 44.4%). Patients receiving etomidate had significantly shorter induction times (P = 0.02; difference of means 2.1 minutes, 95% CI 0.35 to 3.86), sedation times (P < 0.001; difference of means 31.3 minutes, 95% CI 24.0 to 38.5), and total examination times (P < 0.001; difference of means 53.1 minutes, 95% CI 40.8 to 65.3). Significantly more parents in the etomidate group perceived their child to be back to baseline by discharge from the hospital (P < 0.001; difference of proportions 60.7, 95% CI 29.1 to 92.4) and expressed fewer concerns about their child's behavior after discharge (P = 0.024; difference of proportions 28.6, 95% CI 6.5 to 50.7). Conclusions: At the dosing used in this study, pentobarbital is superior to etomidate when comparing success rates for sedation. However, among the successful sedations, the duration of sedation was shorter in the etomidate group than in the pentobarbital group. Pentobarbital is associated with more frequent side effects and parental concerns compared to etomidate.

KW - CT

KW - Etomidate

KW - Imaging

KW - Pentobarbital

KW - Sedation

UR - http://www.scopus.com/inward/record.url?scp=4143075898&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=4143075898&partnerID=8YFLogxK

U2 - 10.1097/01.pec.0000136065.22328.df

DO - 10.1097/01.pec.0000136065.22328.df

M3 - Article

C2 - 15295244

AN - SCOPUS:4143075898

VL - 20

SP - 499

EP - 506

JO - Pediatric Emergency Care

JF - Pediatric Emergency Care

SN - 0749-5161

IS - 8

ER -