6877 Safe, successful sedation: improving the oral sedation protocol for paediatric patients

Objectives Magnetic resonance imaging (MRI) is widely used in paediatrics as it provides high quality imaging without exposing patients to harmful radiation. However, its use is restricted due to poor patient tolerance caused by the lengthy acquisition times and confined and loud environment. Oral sedation with chloral hydrate has helped promote the use of MRI in paediatric patients by improving tolerance.¹ In 2019, the paediatric oral sedation protocol at a district general hospital (protocol 1) was amended to reflect the new BNFC guidance (protocol 2).² Two previous audits demonstrated a reduction of 3% in the sedation success rates on comparing protocols 1 and 2. The mean successful total doses for different weight groups from these initial audits were analysed and used to formulate an updated dosing protocol 3 (table 1). This quality improvement project aims to compare the sedation success rates between the previous and updated oral sedation protocols. Methods An oral sedation proforma was used to collect data retrospectively from August to December 2021. 33 patients who attended for outpatient tests or procedures requiring sedation and who received chloral hydrate only were included. Data was collected regarding the patients' ages, weights, initial and top up chloral hydrate doses, sedation success and adverse effects. Results This audit cycle demonstrated an improved sedation success rate of 94% on implementation of the updated protocol 3, when compared to protocols 1 and 2 (figure 1). 45% of the successful sedation cases also required a top up dose. Further review of the unsuccessful sedation cases indicated an inability to give the chloral hydrate top up dose, due to time restraints or the maximum dose already being given. Additionally, no serious adverse effects were identified in any of the cases. Non-pharmacological measures, such as preparatory appointment letters, allocated quiet sedation spaces and prompt administration of the top up chloral hydrate dose at 20–25 minutes, were also identified as potential aids to improving sedation success. Conclusion Utilising a chloral hydrate dosing protocol which considers the age, weight, and activity level of the patient and administering a top up dose are associated with improved oral sedation success rates. Furthermore, non-pharmacological interventions should be considered as adjuncts in facilitating effective and safe sedation. Future work is required to assess the sedation success rate of protocol 3 with a larger sample size and to determine the role of non-pharmacological interventions in promoting effective sedation. References Artunduaga M, Liu CA, Morin CE, Serai SD, Udayasankar U, Greer MC, et al. Safety challenges related to the use of sedation and general anesthesia in pediatric patients undergoing magnetic resonance imaging examinations. Pediatr Radiol 2021 May 1,51(5):724–735. Paediatric Formulary Committee. BNF for Children (online) London: BMJ, Pharmaceutical Press, and RCPCH Publications <https://bnfc.nice.org.uk/drugs/chloral-hydrate/> [Accessed on 28 October 2023]