Efficacy and safety of intravenous thiamylal in pediatric procedural sedation for magnetic resonance imaging

Irie, Shinji; Hirai, Katsuki; Kanô, Kyoko; Yanabe, Shuichi; Migita, Masahiro

doi:10.1016/j.braindev.2020.04.005

Cited by 8 publications

(11 citation statements)

References 17 publications

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“…20,21,22 In Japan, propofol is off-label for sedation outside the operating room and is used with caution due to reports regarding its association with some deaths in pediatric patients. 23 Contrastingly, our results revealed that oral triclofos sodium was the most commonly used sedative (51.7%). Further, there was an increasing trend in barbiturate use and decreasing trends in the use of triclofos sodium and chloral hydrate in Japan.…”

Section: Discussioncontrasting

confidence: 67%

“…In the United States, propofol remains the most popular sedative agent because of its rapid onset and emergent properties 20,21,22 . In Japan, propofol is off‐label for sedation outside the operating room and is used with caution due to reports regarding its association with some deaths in pediatric patients 23 . Contrastingly, our results revealed that oral triclofos sodium was the most commonly used sedative (51.7%).…”

Section: Discussionmentioning

confidence: 63%

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Trends and patterns in the practice of pediatric sedation for magnetic resonance imaging in Japan: A longitudinal descriptive study from 2012 to 2019

Tsuji

Sato

Kamimura

et al. 2022

Pediatric Anesthesia

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Background: Worldwide, pediatric sedation for magnetic resonance imaging is a standard practice; however, there are few studies on its trends and patterns. Aims: This study aimed to investigate the trends and patterns of pediatric sedation for magnetic resonance imaging in Japan and determine the incidence of and risk factors for adverse events/interventions. Methods: This longitudinal descriptive study assessed children (age < 15 years) who underwent sedation for magnetic resonance imaging between April 2012 and December 2019 in Japan using a nationwide claims database. We assessed the patients' demographic characteristics, time trends in sedatives, sedative patterns by age, and adverse events/interventions within two post-sedation days. Further, we used multivariable logistic regression models to explore factors related to the incidence of adverse events/interventions. Results:We identified 29 187 cases (median age, 2.0 years; 55.2% males). The most common sedative was triclofos sodium (n = 18 812, 51.7%). There was an increasing trend in barbiturate use (17.0% [2012] to 25.0% [2019]) and decreasing trends in the use of triclofos sodium (56.4% [2012] to 47.7% [2019]) and chloral hydrate (15.6%[2012] to 10.8% [2019]). We identified 534 adverse events/interventions in 460 cases (1.5%). Multivariable logistic regression analyses revealed that the incidence of adverse events/interventions mainly increased with the number of sedatives (≥3; adjusted odds ratio, 5.10; 95% confidence interval, 3.67-7.10) and unscheduled setting (adjusted odds ratio, 6.28; 95% confidence interval, 4.85-8.61); further, it decreased with high hospital procedure volume (adjusted odds ratio, 0.62; 95% confidence interval, 0.49-0.78). Conclusions:Based on a Japanese real-world setting, there is an increasing trend in barbiturate use and decreasing trends in the use of triclofos sodium and chloral hydrate in pediatric sedation for magnetic resonance imaging. Low hospital procedure volumes were associated with an increased risk of adverse events/interventions.

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Section: Discussioncontrasting

confidence: 67%

Section: Discussionmentioning

confidence: 63%

Trends and patterns in the practice of pediatric sedation for magnetic resonance imaging in Japan: A longitudinal descriptive study from 2012 to 2019

Tsuji

Sato

Kamimura

et al. 2022

Pediatric Anesthesia

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“… 14) Moreover, thiamylal is widely used for sedation in children in Japan. 6 , 7 , 15) Therefore, we believe that thiamylal is a good candidate drug to provide novel protective findings of prophylactic barbiturate in patients with sTBI. Indeed, our novel sdB could control the serum concentration within the safety margin ( Fig.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of a Novel Prophylactic Barbiturate Therapy for Severe Traumatic Brain Injuries: Step-down Infusion of a Barbiturate with Normothermia

Kajiwara

Hasegawa

Negoto

et al. 2021

Neurol. Med. Chir.(Tokyo)

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This study aimed to examine the beneficial effects of a novel prophylactic barbiturate therapy, step-down infusion of barbiturates, using thiamylal with normothermia (NOR+sdB), on the poor outcome in the patients with severe traumatic brain injuries (sTBI), in comparison with mild hypothermia (MD-HYPO). From January 2000 to March 2019, 4133 patients with TBI were admitted to our hospital. The inclusion criteria were: a Glasgow coma scale (GCS) score of ≤8 on admission, age between 20 and 80 years, intracranial hematoma requiring surgical evacuation of the hematoma with craniotomy and/or external decompression, and patients who underwent management of body temperature and assessed their outcome at 6-12 months. Finally, 43 patients were included in the MD-HYPO (n = 29) and NOR+sdB (n = 14) groups. sdB was initiated intraoperatively or immediately after the surgical treatment. There were no significant differences in patient characteristics, including age, sex, past medical history, GCS on admission, type of intracranial hematoma, and length of hospitalization between the two groups. Although NOR+sdB could not improve the patient's poor outcome either at discharge from the intensive care unit (ICU) or at 6-12 months after admission, the treatment inhibited composite death at discharge from the ICU. The mean value of the maximum intracranial pressure (ICP) in the NOR+sdB group was <20 mmHg throughout the first 120 h. NOR+sdB prevented composite death in the ICU in patients with sTBI, and we may obtain novel insights into the beneficial role of prophylactic barbiturate therapy from suppression of the elevated ICP during the first 120 h.

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“…Episodes of upper airway obstruction such as snoring, stridor, pharyngeal obstruction, and laryngospasm were managed by airway maneuvers (jaw thrust or chin lift). Oxygen desaturation was defined as SpO 2 < 94% [ 25 ]. If the obstruction or desaturation was unresolved, patients received increased concentration of inspired oxygen and airway interventions (oropharyngeal airway, face mask ventilation, laryngeal mask airway, tracheal intubation, and positive-pressure ventilatory assistance).…”

Section: Methodsmentioning

confidence: 99%

Effect of esketamine vs dexmedetomidine adjunct to propofol sedation for pediatric 3Tesla magnetic resonance imaging: a randomized, double-blind, controlled trial

Shan

Gao

et al. 2022

Eur J Med Res

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Background Adequate sedation is essential for pediatric patients undergoing 3Tesla (T) magnetic resonance imaging (MRI). Using propofol alone is associated with patient arousing and adverse airway events. This study aimed to assess esketamine vs dexmedetomidine adjunct to propofol sedation for pediatric 3 T MRI. Methods In this randomized, double-blind, controlled trial, 114 pediatric patients aged between 6 months and 8 years were randomly assigned, in a 1:1 ratio, to the esketamine–propofol group or the dexmedetomidine–propofol group. Sedation was provided with esketamine or dexmedetomidine in combination with propofol titration. The primary outcome was the total dose of propofol. Secondary outcomes included propofol infusion dose, adverse events, time to emergence from sedation, and time to discharge from recovery room. Results A total of 111 patients completed this study (56 in the esketamine–propofol group and 55 in the dexmedetomidine–propofol group). All MRI procedures were successfully performed under sedation. The total median (IQR) dose of propofol was significantly lower in the esketamine–propofol group (159.8 [121.7, 245.2] μg/kg/min) than that in the dexmedetomidine–propofol group (219.3 [188.6, 314.8] μg/kg/min) (difference in medians [95% CI] = − 66.9 [− 87.8 to − 43.0] μg/kg/min, P < 0.0001). The use of esketamine resulted in a lower dose of propofol for titration (difference in medians [95% CI] = − 64.3 [− 75.9 to − 51.9] μg/kg/min), a shorter time to emergence (difference in means [95% CI] = − 9.4 [− 11.4 to − 7.4] min), and a reduced time to recovery room discharge (difference in means [95% CI] = − 10.1 [− 12.1 to − 8.2] min). In the dexmedetomidine–propofol group, 2 patients experienced upper airway obstruction and 6 patients had bradycardia. No episodes of oxygen desaturation or other adverse events were observed. Conclusions Although both regimens provided effective sedation for pediatric 3 T MRI, the esketamine–propofol sedation reduced propofol requirement and facilitated recovery, without detection of increased adverse effects in the studied population. Trial registration Chinese Clinical Trial Registry (identifier: ChiCTR2100048477).

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Efficacy and safety of intravenous thiamylal in pediatric procedural sedation for magnetic resonance imaging

Cited by 8 publications

References 17 publications

Trends and patterns in the practice of pediatric sedation for magnetic resonance imaging in Japan: A longitudinal descriptive study from 2012 to 2019

Trends and patterns in the practice of pediatric sedation for magnetic resonance imaging in Japan: A longitudinal descriptive study from 2012 to 2019

Efficacy of a Novel Prophylactic Barbiturate Therapy for Severe Traumatic Brain Injuries: Step-down Infusion of a Barbiturate with Normothermia

Effect of esketamine vs dexmedetomidine adjunct to propofol sedation for pediatric 3Tesla magnetic resonance imaging: a randomized, double-blind, controlled trial

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