Sedation and monitoring of paediatric patients undergoing open low‐field MRI

Abstract

Rupprecht T, Kuth R, Bowing B, Gerling S, Wagner M, Rascher W. Sedation and monitoring of paediatric patients undergoing open low-field MRI. Acta Paediatr 2000; 89: 1077-8 I. Stockholm.The purpose of this study was to determine the need, effectiveness and safety of sedation and monitoring in infants and children in a paediatric open low-field MRI system. Of 274 patients (median age 9y) examined, only 74 children (median age 25 mo) needed sedation. Sedation was achieved by intravenous administration of midazolam (0.2 mgkg) and etomidate (0.2 mgkg). Mean total doses required were 0.28 and 0.27 mgkg, respectively. With the exception of eight primarily ventilated patients, all children breathed spontaneously. 0 2 saturation, arterial blood pressure and ECG were monitored. The low resonance frequency of the MRI system required a specially designed high frequency (HF) shielding of the monitor system to avoid HF artifacts. The overall sedation rate was markedly lower (74/274 = 27%) compared to a control group previously examined in a closed high-field MRI system (52/111 = 47%). This was due to a significant lower need for sedation in patients aged up to 10 y (p 5 0.0001) in the open MRI unit. General anaesthesia could be avoided in all patients. No significant movement artifacts occurred in any of the MRI examinations and no serious side effects were observed.Conchwm: MRI of children is easier in an open MRI system and with fewer sedations, as in closed hi@-field systems. Sedation by a combination of rnidazolam and etomidate is highly effective and safe. M o n i t o r i n g devices for high-field systems may have to be modified for low-field systems. An inhowe pnediatric MRI unit with an open and special paediatric design is of major advantage for imaging pediatric patients. ) Harte GJ. Gray PH, Lee TC, Steer PA, Charles BG. Haemodynamic responses and population pharmacokinetics of midazolam following administration to ventilated, preterm neonates. J Paediatr Child Health 1997; 33: 335-8 Gremse DA, Kumar S, Sacks AI. Conscious sedation with highdose midazolam for pediatric gastrointestinal endoscopy. South Med J 1997; 90: 821-5 Cote CJ. Sedation for the pediatric patient. A review. Pediatr Clin

Image quality associated with the use of an MR-compatible incubator in neonatal neuroimaging

“…Refinement of conventional MR techniques includes the use of ultrafast MR sequences in moving patients and the Periodically Rotated Overlapping Parallel Lines with Enhanced Reconstruction technique for motion correction [9,10]. If motion artefact continues to affect image quality, sedation or anaesthesia may be required, but this approach carries a small but definite risk of adverse events and sedated neonates require careful monitoring [5,6,[11][12][13]. At our unit, we do not routinely administer sedation to neonates who are imaged using the MR-compatible incubator.…”

Interventions to Reduce Anxiety, Distress, and the Need for Sedation in Pediatric Patients Undergoing Magnetic Resonance Imaging: A Systematic Review

“…Data have been synthesized where possible. Rupprecht et al (2000) performed a comparable cohort study with a retrospective control group of open lowfield (0.2 T) MRI system (274 children: 136 males and 138 females) compared with a closed high-field MRI (111 children: 68 males and 43 females) in children older than 2 years in Germany. For children undergoing imaging in the open scanner, 74 children (27%) required sedation compared with 52 children (47%) in the closed scanner (p % .001).…”

“…This includes the use of mock MRI (Carter et al, 2010), in which children experience simulations to determine their tolerance before their MRI, cognitive behavioral therapies, such as guided imagery or relaxation training (Smart, 1997;Tyc, Leigh, Mulhern, Srivastava, & Bruce, 1997), open MRI (which can seem less intimidating than conventional MRI) (Rupprecht, Kuth, Bowing, Gerling, Wagner, & Rascher, 2000), additional information (Hartman, Bena, Mclntyre, & Albert, 2009), and audiovisual (AV) strategies (Lemaire, Moran, & Swan, 2009). However, no systematic review currently exists to summarize the existent evidence on this topic and provide guidance to health professionals working with children in health care.…”

Untersuchungstoleranz von Kindern und Adoleszenten in einem 1,5 Tesla MR-Tomografen mit offenem Magnetdesign

“…MRT-Untersuchungen sind im Kindesalter häufig nur mittels einer Sedierung, selten sogar nur in Vollnarkose, durchzuführen, um bei Untersuchungszeiten von 30 -60 Minuten je nach Fragestellung, eine qualitativ aussagekräftige MRT-Untersuchung zu gewährleisten. Bei Kindern im Kleinkindalter ist eine solche Sedierung meist unumgänglich [1], bei älteren Kindern kann jedoch eine offene Bauweise der Tunnelçffnung helfen, die Sedierungsraten zu verringern [7]. Rupprecht et al berichteten 2001 über ihre Erfahrungen von pädiatrischen MRT-Untersuchungen in einem 0,2 Tesla MAGNETOM Open und fanden eine niedrigere Sedierungsrate bei jedoch verlängerter Untersuchungszeit und schlechterem Signal-zu-Rausch-Verhältnis im Vergleich zu Hochfeldgeräten [8].…”