NEW update **Some questions for BBB nurses and doctors

[JTsMom]

Several rounds of calls later, we're all in the same page! General anesthesia it is. Thank you all for helping me, and for all of the encouragement.

We had to reschedule for Oct. Now we just have to get through the test, and get some good results!
******************************************
This is not going so well. I just got done with another round of phone calls. Here's what I found out:

The meds they used for that last sedated echo were Demerol and Pentobarbital. The nurse said that the Pentobarbital will not be a good combo with the Propyfol, so that's probably out.

They can't do a gas induction b/c they don't have the equipment there.

She gave me the "We do this all the time. You can talk to the doc that day." speech, but I told her I wanted to have a plan in place ahead of time, so she's going to talk to the doctor who will be there and get back to me on Wednesday. I'm not holding my breath. My next line of defense is our cardiologist, and if that doesn't work, I'm wondering if I can't get this done elsewhere.


*****************************************
I'm going to do my best not to turn this into a novel.

I'm looking for any thoughts or advice you might have.

Jason has to have a cardiac MRI done next month. They typically use IV Propyfol for them. There is no way that I can express the battle that will ensue if we have to put an IV into this child without some sort of heavy duty pharmaceutical assistance. He has sensory issues, and something like looking in his ears causes a knock down drag out. We've done tons of echos, and they are always a battle, even though he knows they aren't painful. And yes, we've tried role-playing, explaining, bribing, letting him hold the equipment, etc.

Issue #2 is that Jason is difficult to sedate. At 13 months, he had a cath done. Afterwards, they had to do an echo to clear us to go home, and it took 3 drugs to knock him out. I know the first one was something akin to Benadryl, and the other 2 were Atavan and Versed, but the hospital was unable to tell me which order they were given in (I'm ordering the records, but they'll take a while to arrive). After the first two, he was still RUNNING up and down the halls with his eyes closed. The nurses and doctors were amazed.

I've spoken with a couple of people, including a nurse in that department, and explained the whole situation. I was hoping they'd agree to use an oral sedative. We used one a few years ago there for a sedated echo, and it worked well. It was the same combo they use for cardiac caths (they didn't want to mess around, so they went right for the big guns).

The nurse tells me the doctors will be reluctant to use those drug this time though, and she recs using Versed, then doing the IV, but I'm concerned we might have the paradoxical reaction again, and/or that it won't be enough to get him to cooperate, and then we'll have to hold him down, and do it anyway, which I really do not want to do. He tends to carry these things with him emotionally for a long time, and we have a mess of appointments this month that I really don't want him to be traumatized for. I really don't understand how that drug combo would be strong enough to use for cardiac caths, but not strong enough to use for an MRI. What am I missing?

Any advice is appreciated.

[Uno-Mom]

Wow good luck.

No advice, I'm afraid, but I know how much that sucks. I work with some folks who have similar issues and that scenario has led to some ER nightmares.

[swissair81]

I have seen kids who have been given enough Versed to knock out an elephant. It has to be a paradoxical reaction. There is nothing else to explain it.

I wish I knew what to tell you. I don't have pediatric experience, other than with newborns.

[kwc]

Lori, PM'd you.

[elephantmeg]

I know in my days as a peds ambulatory surgery nurse I had a kid that wouldn't do versed so we ended up doing PO ativan-but he was like 10 or 11... DD had propofol daily for her dressing changes but had an existing IV and no sensory issues. The other thing we would do for kids under 10 is a mask induction (anesthesia) and then put in an IV. This was mostly for adnoids. For ear tubes they just used the gas... I wonder if having anesthesis put him out for the IV is an option at all....

[tarahsolazy]

I'd probably do oral chloral hydrate, and then the IV when he was sleepy from that. Clearly, benzodiazepines like Versed don't work for him, at least when given by mouth. Chloral hydrate is totally old school, but can work really well. What about L-Max or EMLA cream over the IV insertion sites beforehand? I know its the manipulation of his arms that he probably hates, but if the stick didn't hurt, it might be easier. Good Luck!

[JTsMom]

I know in my days as a peds ambulatory surgery nurse I had a kid that wouldn't do versed so we ended up doing PO ativan-but he was like 10 or 11... DD had propofol daily for her dressing changes but had an existing IV and no sensory issues. The other thing we would do for kids under 10 is a mask induction (anesthesia) and then put in an IV. This was mostly for adnoids. For ear tubes they just used the gas... I wonder if having anesthesis put him out for the IV is an option at all....

That would probably be ideal. I wonder if that is an option?

[JTsMom]

I'd probably do oral chloral hydrate, and then the IV when he was sleepy from that. Clearly, benzodiazepines like Versed don't work for him, at least when given by mouth. Chloral hydrate is totally old school, but can work really well. What about L-Max or EMLA cream over the IV insertion sites beforehand? I know its the manipulation of his arms that he probably hates, but if the stick didn't hurt, it might be easier. Good Luck!

I'll ask about chloral hydrate too. They did mention using EMLA cream, but you're right- the freak out is going to start long before we even get to the insertion of the IV.

I've been convinced, via PM's, that it's probably best to speak directly to the doctors involved ahead of time, so I'll make some more phone calls. It will definitely help to have some concrete ideas to bring up, so thank you again to everyone for your suggestions.

[mushka]

You need to request an anesthesiologist or pediatric anesthesiologist to provide sedation for your child for the MRI. We do it all the time. I never start an IV on an awake child. I usually give oral Versed for amnesia. I do a mask induction with the parent present in the room. Once the child is asleep I start an IV. If the MRI suit has an anesthesia machine I keep patients asleep with gas, if there is no machine, I do propofol drip. All you have to do is request anesthesia for MRI.

[jren]

When DD had an MRI, they gave her Versed and then used the mask prior to placing an IV. We will never do Versed again! She was more awake after taking that than before and remembered everything including blowing up the balloon. But six hours after the Versed was given she was having hallucinations and still unable to walk (of course after we were sent home). Anyway, she tells me she was a little nervous when she had to go back to the MRI room without me and seeing all the equipment. She's 6 and no sensory issues. Will they allow you back with him?