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01-04-2011 | Artikel

Succesvolle en veilige sedatie voor MRI-onderzoek bij kinderen

De dagelijkse praktijk in Nederland getoetst aan de resultaten van een systematic review van de literatuur

Auteurs: Dhr. drs. Piet L.J.M. Leroy, Dhr. drs. Jonathan I. M. L. Verbeke, Dhr. dr. Fred H. M. Nieman, Mw. drs. Heleen H. E. A. Blokland-Loggers

Gepubliceerd in: Tijdschrift voor Kindergeneeskunde | Uitgave 2/2011

Samenvatting

Tijdens magnetisch resonantie-onderzoek (MRI) hebben jonge kinderen en kinderen met een vertraagde ontwikkeling een vorm van procedurele sedatie (PS) nodig om voldoende (lang) bewegingloos te kunnen blijven liggen. In Nederland hebben zich in het afgelopen decennium ernstige ongevallen voorgedaan tijdens PS voor MRI. Het is aangetoond dat essentiële veiligheidsrichtlijnen ten aanzien van PS onvoldoende geïmplementeerd zijn in de Nederlandse algemene kindergeneeskundige praktijk. Tevens bestaan er zorgen over de matige effectiviteit van vaak toegepaste PS-protocollen. Door middel van een enqueˆte onderzochten we welke PS-technieken en -medicijnen algemeen kinderartsen meestal gebruiken voor MRI bij kinderen. De gemiddelde praktijk werd vergeleken met de resultaten van een systematische review (SR) van de recente literatuur. Door middel van de SR proberen we de klinische vraag te beantwoorden wat op de kinderleeftijd de veiligste en meest effectieve techniek is voor PS tijdens MRI. Nederlandse kinderartsen doen voor MRI zelden beroep op anesthesie. Meestal wordt gebruikgemaakt van een PS op basis van chloralhydraat, midazolam en/of lytische cocktails. Deze sedativa hebben een suboptimale effectiviteit. Het is onbekend hoeveel onderzoeken hierdoor geheel of gedeeltelijk mislukken. Deze medicijnen hebben wel een reëel risico op ernstige complicaties. Het gebruik moet daarom steeds gepaard gaan met verregaande voorzorgsmaatregelen en de aanwezigheid van competente professionals. Van alle sedativa heeft propofol de hoogste effectiviteit. Propofol kan veilig worden gebruikt door competente nietanesthesiologen. Indien deze professionals niet beschikbaar zijn, verdient het aanbeveling om kinderen die gesedeerd moeten worden voor MRI, door te verwijzen naar een anesthesioloog.

volgende artikel Geen meningeale prikkeling, toch meningitis?

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Titel: Succesvolle en veilige sedatie voor MRI-onderzoek bij kinderen
De dagelijkse praktijk in Nederland getoetst aan de resultaten van een systematic review van de literatuur
Auteurs: Dhr. drs. Piet L.J.M. Leroy
Dhr. drs. Jonathan I. M. L. Verbeke
Dhr. dr. Fred H. M. Nieman
Mw. drs. Heleen H. E. A. Blokland-Loggers
Publicatiedatum: 01-04-2011
Uitgeverij: Bohn Stafleu van Loghum
Gepubliceerd in: Tijdschrift voor Kindergeneeskunde / Uitgave 2/2011
Print ISSN: 0376-7442
Elektronisch ISSN: 1875-6840
DOI: https://doi.org/10.1007/s12456-011-0008-9

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