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23-Jul-2017 19:26

The Association of Anaesthetists recommends that monitoring standards should be the same for sedation and anaesthesia: continuous ECG and pulse oximetry, some means of measuring respiration such as end tidal CO monitoring, frequent blood pressure estimations, and inspired oxygen concentration monitoring if the patient is breathing from a gas delivery system.1-7 The cost of anaesthetic equipment cannot be avoided if the children who failed to be sedated are dealt with on the same site.Comparable grades of paediatrician, radiologist, and anaesthetist cost the same although nurse sedationists cost less.To decide between sedation and anaesthesia it will be helpful to compare how they meet the requirements for scanning.General anaesthesia produces an immobile patient who will stay unconscious until the end of the procedure.

A comparison between sedation and anaesthesia for upper gastrointestinal endoscopy in children showed a higher incidence of desaturations and arrhythmias in the sedation group.1-11 As well as Coté 's collection of sedation disasters,1-12 there are many other reports of serious incidents,1-11 1-13-1-15 one mentioning nine deaths and 18 episodes of respiratory arrest occurring during sedations carried out by 129 radiologists.1-15 There seems no reason why the standard of care expected by the courts during sedation should be any lower than that during anaesthesia, and the responsibility for sedations delegated to nurses or trainee radiologists or paediatricians, who may lack the authority to interrupt a scan,1-16 will remain with the delegating consultant.1-17 Recently, in the UK a child received almost £4 million in compensation for hypoxic brain damage1-18 and there is the ever present fear of a manslaughter charge when a patient dies.1-19 Safety would seem to be a decisive argument in favour of general anaesthesia.

There is little evidence that antihistamines used symptomatically to treat nonspecific itching have any effect greater than placebo.