Sedation and general anaesthesia in children undergoing MRI and CT: adverse events and outcomes

Abstract

Quality assurance data were collected prospectively for children who were sedated (n = 922) or given general anaesthesia (n = 140) for magnetic resonance imaging (MRI) or computerized tomography (CT). The data included patient characteristics, concurrent medication, adequacy of sedation, adverse events and requirement for escalated care. The quality of scans was evaluated. Reasons for preselection of general anaesthesia included previously failed sedation (28%), potential for failed sedation (32%) and perceived medical risk (14%). Hypoxaemia occurred in 2.9% of sedated children, and was more common in children classified as ASA III or IV. Sedation was inadequate for 16% of children and failed in 7%. Failed sedation was associated with greater age (P = 0.009), higher ASA status (P = 0.04) and use of benzodiazepines as sole sedatives (P < 0.03). More of the children who underwent general anaesthesia were ASA III or IV than sedated children, yet the procedure was successful in all the children who underwent general anaesthesia, with one incident of laryngospasm. Excessive motion was noted in 12% of scans of sedated children and 0.7% of those completed with general anaesthesia. We conclude that sedation of children for MRI and CT is associated with risks of hypoxaemia and of inadequate or failed sedation. These adverse events were more likely to occur in older children, those with a higher ASA status and those in whom benzodiazepines had been used as sole sedatives. For a preselected high-risk group of children, general anaesthesia may make MRI and CT scans more successful with minimal adverse events.

Anaesthesia for Paediatric Cardiac MRI

“…In our opinion, general anaesthesia with paralysis and controlled ventilation offers several advantages over intravenous sedation in infants and young children. These patients with limited cardiovascular reserve and cyanotic CHD are prone to desaturate to lower levels in the event of sedation induced respiratory depression or airway obstruction [10]. Besides, effects of sedation can be unpredictable and some of the drug combinations may be associated with delayed recovery.…”

Effects of Intraoperative Magnetic Resonance Imaging on the Neuromuscular Blockade of Vecuronium Bromide in Neurosurgery

“…However, there are some problems with MR imaging which pose risks to the medical personnel and patients. 13,18) In 2009, the ASA formulated suggestions for the safe management of iMR imaging, 16) and showed that iMR imaging could increase the core body temperature of the patients. MR imaging could increase the core body temperature by 0.3-0.79 C in patients under sedation or general anesthesia.…”

“…MR imaging could increase the core body temperature by 0.3-0.79 C in patients under sedation or general anesthesia. 5,13) To evaluate the energy absorbed by the human body, the concept of absorption of radio frequency energy has been proposed (specific absorption rate: SAR). SAR refers to the radiofrequency energy that a unit weight of the human body absorbs within a unit time.…”

Patient’s Comfort and Technical Quality Exams at 1.5 and 3.0 T Magnetic Resonance Imaging

“…In some cases, sedation is not sufficient, so it is necessary to introduce the patient in a short-term general anesthesia. In addition to the possible side effects of anesthesia [16] [17] there are also additional costs due to a disrupted and reduced working process (workflow), limited ability of the patient to cooperate and the spent time intended for imaging [18].…”