Drug selection for sedation and general anesthesia in children undergoing ambulatory magnetic resonance imaging

Abstract

The prevalence of magnetic resonance imaging (MRI) for diagnosing and monitoring a wide range of disease in children continues to expand with the efficacy benefit of providing high-resolution images of tissue anatomy and quantitative function and the safety advantage of a lack of ionizing radiation [1,2]. Aspects of MRI scans such as loud noises, confined bore of the magnet, and the required immobility to prevent motion artifacts are the causes of anxiety and barriers to successful performance of the procedure in children younger than 6 years and those at any age with development delay, claustrophobia, or involuntary movements or con-The demand for drug-induced sedation for magnetic resonance imaging (MRI) scans have substantially increased in response to increases in MRI utilization and growing interest in anxiety in children. Understanding the pharmacologic options for deep sedation and general anesthesia in an MRI environment is essential to achieve immobility for the successful completion of the procedure and ensure rapid and safe discharge of children undergoing ambulatory MRI. For painless diagnostic MRI, a single sedative/anesthetic agent without analgesia is safer than a combination of multiple sedatives. The traditional drugs, such as chloral hydrate, pentobarbital, midazolam, and ketamine, are still used due to the ease of administration despite low sedation success rate, prolonged recovery, and significant adverse events. Currently, dexmedetomidine, with respiratory drive preservation, and propofol, with high effectiveness and rapid recovery, are preferred for children undergoing ambulatory MRI. General anesthesia using propofol or sevoflurane can also provide predictable rapid time to readiness and scan times in infants or children with comorbidities. The selection of appropriate drugs as well as sufficient monitoring equipment are vital for effective and safe sedation and anesthesia for ambulatory pediatric MRI.

Using intranasal dexmedetomidine with buccal midazolam for magnetic resonance imaging sedation in children: A single-arm prospective interventional study

“…In our study, 0.4% of patients vomited during the procedure, and 3.4% reported gastrointestinal upset in the 24-h post-sedation survey. This value was lower than that of adverse events observed with oral chloral hydrate and pentobarbital ( 30 ). A wide distribution was observed during the time to resume normal activities in the survey.…”

“…The success rates of other traditional non-parenteral sedatives in MRI sedation were 86.7% for chloral hydrate in children aged 0 to 10 years ( 27 ), 67% for pentobarbital in children aged 8 months to 8 years ( 28 ), and 59% for midazolam in children aged 1 to 7 years ( 29 ). A previous study revealed that the success rate of dexmedetomidine sedation varied with age, weight and disease ( 30 ). In the current study, we have shown that history of sedation failure was the only risk factor contributing to sedation failure and this finding was consistent with Liu’s study on intranasal dexmedetomidine–ketamine combination ( 31 ).…”

Artificial intelligence in paediatric radiology: Future opportunities

“…In paediatric imaging, reduced MRI scanning times would not only allow for more studies to be performed per day, but also contribute to reduced motion artefacts by a less co-operative child 23 and could reduce the need for general anaesthesia and its associated risks. 24 A variety of AI-assisted techniques are being assessed, 25,26 but have predominantly included training a neural network to learn relationships between zero-filled k-space data and those of fully sampled k-space data for a particular study type; thereby allowing for interpolation of missing data in future unseen studies (e.g., in adult brain imaging) 21,27 ; and also by using neural networks to remove aliasing from under-sampled real-time MR data to enhance image reconstruction times (e.g., used in MRI reconstruction of congenital heart diseases in children). 28 In this technique, deep learning artefact suppression reconstructions were reportedly over five times faster than conventional (compressed sensing) image reconstruction methods.…”

A Novel Propofol Dosing Regimen for Pediatric Sedation during Radiologic Tests

“…Due to their anatomical and physical characteristics, children are vulnerable to side effects of sedatives, such as airway obstruction, apnea, and hypotension. For successful completion of procedures without the side effects of sedatives, an appropriate selection of sedatives and determination of dosage are crucial [ 3 , 4 ].…”