Magnetic Resonance Imaging under Sedation in Pediatric Patients: A Single-Institution Experience

Abstract

Magnetic resonance imaging (MRI) scans for children are a challenge for anesthesiologists since the child must be sedated enough to stand still. But anesthetic drugs used for sedation might have serious side effects and monitorization resources and accessibility to the patient during MRI scan is limited. We retrospectively examined 977 pediatric patients' files who had MRI scans in our hospital. We observed that children received one of the four combinations of anesthetic drugs: group 1 received midazolam, propofol, and ketamine; group 2 received midazolam and ketamine; group 3 received midazolam and thiopental; and group 4 received midazolam and propofol combination for sedation. The patients in group 1 had significantly higher vomiting rates than the patients in group 4 (p = 0.005). We observed bronchospasm in patients in group 1 (p = 0.006) and group 3 (p = 0.001), more than in patients in group 4. Nausea and vomiting ratios were lower in group 4. In patients with nausea and vomiting within a week after the procedure, statistically significant lower neutrophil–lymphocyte ratio values (p = 0.012) were observed. All four anesthetic combinations used in the trial provided safe anesthesia for the children, during the MRI scan. The anesthetic choice must be made according to the procedure time and patient's comorbidities. In this trial, we observed minimum side effects with midazolam and propofol combination.

Comparison of airway collapsibility following single induction dose ketamine with propofol versus propofol sedation in children undergoing magnetic resonance imaging: A randomised controlled study

“…[ 2 ] Propofol is most commonly preferred in children for sedation. [ 3 ] Nonetheless, deep sedation with high doses can predispose to airway obstruction, while lower doses may cause movement, necessitating repetition of an MRI scan. [ 3 4 ] Ketamine provides a patent airway with minimal effect on a respiratory drive and a stable haemodynamic profile.…”

“…[ 3 ] Nonetheless, deep sedation with high doses can predispose to airway obstruction, while lower doses may cause movement, necessitating repetition of an MRI scan. [ 3 4 ] Ketamine provides a patent airway with minimal effect on a respiratory drive and a stable haemodynamic profile. Its combination provides adequate sedation and ventilatory functions and positively affects mood during early cognitive recovery.…”

“…Its combination provides adequate sedation and ventilatory functions and positively affects mood during early cognitive recovery. [ 3 4 5 6 ] Though infusion in children for sedation is commonly achieved using a variety of agents, its effect on paediatric airway dynamics has not been quantified. [ 7 ]…”