Anaesthesia - for paediatric HRCT
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This guideline is designed for Hi-Res Chest CT scans (HRCT) but it may be appropriate to use for other chest CT scans such as when looking for metastases.
Discuss the conditions required for the CT with the radiologist concerned before planning the anaesthetic. Chest CT involves significant doses of radiation - repeat scans are not desirable!
- IV or gaseous induction as appropriate.
- 100% oxygen may increase atelectasis. Use air/oxygen mix where possible. CPAP during induction may help prevent atelectasis.
- Intubate the patient with an endotracheal tube (cuffed or of the appropriate size that allows airway pressures of at least 30cm H2O).
- While positioning the patient and during the "scout" CT ventilate the lungs with 5cm H2O PEEP.
- Check the "scout" CT for endotracheal tube placement and gastric distension. If necessary pass a gastric tube to decompress the stomach and adjust endotracheal tube position.
- Change to the long open-ended rebreathing bag, close APL valve and continue PEEP while ventilating patient from the CT control room.
- Give 10 "alveolar recruitment breaths" before beginning the scan proper.
- The HRCT will require several breathholds in inspiration. If necessary, give whatever pharmacological agent you prefer to allow you to hold the lungs inflated to 25-30cm H2O minimum without patient respiratory efforts (there is a pressure gauge available to use on the end of the long circuit extension) There may be 3 or 4 such sequences.
- Following the inspiratory scans there will be an expiratory scan. Keep the patient apnoeic, reconnect the standard rebreathing bag and open APL valve.
- Review scans. If atelectasis is still present the radiologist may request turning the patient prone.
- Wake the patient/extubate in the routine fashion.
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- Date last published: 01 March 2017
- Document type: Clinical Guideline
- Services responsible: Paediatric Anaesthesia, Paediatric Radiology
- Author(s): Jonathan Warren
- Editor: Michael Tan
- Review frequency: 2 years
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