Nonpharmacological Interventions to Reduce Sedation and General Anesthesia in Pediatric MRI: A Meta-analysis

Abstract

CONTEXT: Nonpharmacological strategies are increasingly used in pediatric procedures, but in pediatric MRI, sedation and general anesthesia are still commonly required. OBJECTIVES: To evaluate the effectiveness of nonpharmacological interventions in reducing use of sedation and general anesthesia in pediatric patients undergoing MRI, and to investigate effects on scan time, image quality, and anxiety. DATA SOURCES: We searched Ovid Medline, CINAHL, Embase, and CENTRAL from inception through October 10, 2022. STUDY SELECTION: We included randomized controlled trials and quasi-experimental designs comparing the effect of a nonpharmacological intervention with standard care on use of sedation or general anesthesia, scan time, image quality, or child and parental anxiety among infants (<2 years), children, and adolescents (2–18 years) undergoing MRI. DATA EXTRACTION: Standardized instruments were used to extract data and assess study quality. RESULTS: Forty-six studies were eligible for the systematic review. Limited to studies on children and adolescents, the meta-analysis included 20 studies with 33 873 patients. Intervention versus comparator analysis showed that nonpharmacological interventions were associated with reduced need for sedation and general anesthesia in the randomized control trials (risk ratio, 0.68; 95% confidence interval, 0.48–0.95; l2 = 35%) and nonrandomized studies (risk ratio, 0.58; 95% confidence interval, 0.51–0.66; l2 = 91%). The effect was largest among children aged 3 to 10 years when compared with older children and adolescents aged 11 to 18 years. LIMITATIONS: There was substantial heterogeneity among nonrandomized studies. CONCLUSIONS: Nonpharmacological interventions must be considered as standard procedure in infants, children, and adolescents undergoing MRI.

Evaluating Sedation Strategies for Magnetic Resonance Imaging: A Comprehensive Review of Intravenous Fentanyl, Butorphanol, and Midazolam in Adult and Pediatric Populations

“…Nonpharmacological interventions have gained traction as alternative approaches to diminish the necessity for sedation and general anesthesia in pediatric MRI settings. These interventions encompass preparation, distraction, and acknowledgment, demonstrating promising results in reducing sedation requirements, particularly among children aged three to 10 years [21]. Notably, the success rate of MRI procedures without sedation or general anesthesia significantly increased with nonpharmacological interventions, underscoring their efficacy in minimizing sedation needs in pediatric imaging contexts [21].…”

“…These interventions encompass preparation, distraction, and acknowledgment, demonstrating promising results in reducing sedation requirements, particularly among children aged three to 10 years [21]. Notably, the success rate of MRI procedures without sedation or general anesthesia significantly increased with nonpharmacological interventions, underscoring their efficacy in minimizing sedation needs in pediatric imaging contexts [21]. In assessing sedative options for pediatric MRI sedation, it is imperative to consider factors like adverse events, recovery time, and success rates.…”

“…Studies indicate that traditional drugs like midazolam and ketamine, while convenient to administer, exhibit lower sedation success rates, prolonged recovery times, and significant adverse events. This underscores the necessity for newer medications with enhanced safety profiles [3,21]. Dexmedetomidine, for instance, is linked to the preservation of respiratory drive, and propofol is recognized for its effectiveness and swift recovery.…”

“…Dexmedetomidine, for instance, is linked to the preservation of respiratory drive, and propofol is recognized for its effectiveness and swift recovery. At the same time, sevoflurane is noted for its mild and nonirritating nature, rendering it a safer option for sedation/anesthesia during MRI procedures [21]. The transition toward safer sedation medications like dexmedetomidine, propofol, and sevoflurane, coupled with the implementation of nonpharmacological interventions, plays a pivotal role in augmenting patient safety, reducing adverse effects, and enhancing the overall experience of individuals undergoing MRI procedures.…”

Using Immersive Virtual Reality Distraction to Reduce Fear and Anxiety before Surgery

“…VR distraction (used in the present study) is another approach. Nonpharmacologic techniques using distraction are being applied during a growing number of medical procedures to provide anxiolysis with the goal of reducing or eliminating the need for sedative administration [11,12]. Immersive virtual reality (VR) is emerging as a sophisticated and effective non-drug technique for anxiety and pain reduction [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30], e.g., during venipuncture [29,30] and even during surgery [31].…”