Comparison of Midazolam and Propofol for Sedation in Pediatric Diagnostic Imaging Studies

Abstract

Propofol seems to be more effective, achieve the appropriate sedation level more quickly, and provide a faster onset of sedation than midazolam in pediatric procedural sedation and analgesia. Propofol is preferred for imaging studies (computed tomography and magnetic resonance imaging) to reduce the occurrence of undesired motion artefacts. Although both drugs are safe to use for sedation before pediatric imaging procedures, propofol is preferred with appropriate preparation.

A comparison of the use of propofol alone and propofol with midazolam for pediatric magnetic resonance imaging sedation – a retrospective cohort study

“…The use of propofol alone tends to increase the incidence of sedation-related serious adverse events, because it has dose-dependent response to upper airway collapse by inhibition of airway dilator muscle and of upper airway reflexes [ 2 , 5 , 8 ]. Therefore, concomitant administration of propofol with other sedative agents, such as midazolam, ketamine and dexmedetomidine, have been evaluated for pediatric procedural sedation [ 2 , 4 , 10 ]. Among various intravenous sedative agents for pediatric procedural sedation, propofol and midazolam have been preferred over others because of their high potency, short half-lives, and low potential of adverse effects [ 10 ].…”

“…Therefore, concomitant administration of propofol with other sedative agents, such as midazolam, ketamine and dexmedetomidine, have been evaluated for pediatric procedural sedation [ 2 , 4 , 10 ]. Among various intravenous sedative agents for pediatric procedural sedation, propofol and midazolam have been preferred over others because of their high potency, short half-lives, and low potential of adverse effects [ 10 ]. In addition, concomitant administration of propofol with midazolam brings drug synergy effect on sedation and contributes to decreased risk of having adverse events [ 4 , 6 ].…”

“…Therefore, by using midazolam and propofol combination regimen, it could provide short induction time, fast recovery, stable cardiorespiratory conditions, and rarely requires additional sedation, and therefore is safe and adequate for pediatric MRI sedation [ 6 , 12 ]. However, midazolam has longer induction and recovery times than propofol, these disadvantages are less severe than those seen with dexmedetomidine [ 10 , 11 ]. In our study, the recovery profile was prolonged in patients administered propofol in combination with midazolam.…”

Sedation for magnetic resonance imaging using propofol with or without ketamine at induction in pediatrics—A prospective randomized double‐blinded study

“…As infants and younger children are unable to lie still for the duration of the examination without drug-induced sleep, a variety of sedation concepts have been implemented by sedation nurses, intensivists, pediatricians, and anesthetists. [1][2][3][4][5][6][7][8][9] In the last few years, propofol sedation has become the standard sedation method with good efficacy, apparent safety, and rapid recovery. 10 The most serious adverse effects of propofol are respiratory depression, apnea, loss of protective reflexes, and hemodynamic deterioration.…”

Craniopagus twins for magnetic resonance imaging

“…Although both drugs are safe to use for sedation before pediatric imaging procedures, propofol is preferred with appropriate preparation. [10]…”