Sedation in Pediatric Patients Undergoing Magnetic Resonance Imaging: An Observational Comparison

Abstract

Background: This study aimed to compare sedation methods in pediatric patients undergoing mag-netic resonance imaging (MRI) using three different anesthetic agents (sevoflurane, thiopental, and propofol) regarding safety, efficacy, time management, and side effects. Materials and Methods: An observational study was conducted with 126 pediatric patients divided into three groups, each receiving one of the three sedative agents: Group S (n = 43), Group T (n = 41), and Group P (n = 42). Patients in Group S received induction with 8% sevoflurane, Group T received 5 mg kg1 of thiopental intravenously, and Group P received 2 mg kg-1 of propofol intrave-nously, followed by maintenance via infusion. Results: The mean age was 37.3 ± 2 months. Cranial MRI was most frequently requested (64.5%). Group P had higher desaturation (p = 0.029) and respiratory depression (p = 0.008) rates. Group T had the shortest induction time (p <0.001), while Group S showed the fastest wake-up times (p = 0.002; p = 0.001). Conclusions: Sevoflurane is distinguished by its rapid emergence from sedation and low incidence of side effects. Thiopental has a quick induction time, whereas propofol is associated with minimal agitation but higher respiratory complications. These findings can guide clinicians in selecting the most appropriate sedation method for pediatric MRI.

Keywords

• Deep sedation
• magnetic resonance imaging
• propofol
• sevoflurane
• thiopental.

Manyetik Rezonans Görüntülemesi Geçiren Pediatrik Hastalarda Sedasyon: Gözlemsel Bir Karşılaştırma

Abstract

Amaç: Bu çalışma, manyetik rezonans görüntüleme (MRG) geçiren pediatrik hastalarda üç farklı anestezik ajan (sevofluran, tiyopental ve propofol) kullanılarak yapılan sedasyon yöntemlerini güven-lik, etkinlik, zaman yönetimi ve yan etkiler açısından karşılaştırmayı amaçladı. Materyal ve Metod: Gözlemsel bir çalışma 126 pediatrik hasta ile gerçekleştirildi ve hastalar üç gruba ayrıldı; her grup üç sedatif ajanından birini aldı: Grup S (n = 43), Grup T (n = 41) ve Grup P (n = 42). Grup S'deki hastalara %8 sevofluran ile indüksiyon, Grup T'deki hastalara 5 mg kg-1 tiyopental intravenöz yolla, Grup P'deki hastalara ise 2 mg kg-1 propofol intravenöz yolla indüksiyon yapıldı ve ardından infüzyon yoluyla idame sağlandı. Bulgular: Ortalama yaş 37,3 ± 2 ay olarak belirlendi. En sık istenen MRG türü kranial MRG idi (%64,5). Grup P'de desatürasyon (p = 0,029) ve solunum depresyonu (p = 0,008) oranları daha yüksekti. Grup T en kısa indüksiyon süresine sahipti (p < 0,001), Grup S ise en hızlı uyanma sürelerini gösterdi (p = 0,002; p = 0,001). Sonuç: Sevofluran, sedasyondan hızlı derlenme ve düşük yan etki insidansı ile öne çıkmaktadır. Tiyopental, hızlı bir indüksiyon süresine sahipken, propofol minimal ajitasyon ancak daha yüksek solunum komplikasyonları ile ilişkilidir. Bu bulgular, pediatrik MRG için en uygun sedasyon yöntemi-ni seçmede klinisyenlere rehberlik edebilir.

Keywords

• Derin sedasyon
• manyetik rezonans görüntüleme
• propofol
• sevofluran
• tiyopental.

References

1. 1. Chandra T, Chavhan GB, Sze RW, Swenson D, Holowka S, Fricke S, et al. Practical considerations for establishing and maintai-ning a magnetic resonance imaging safety program in a pediat-ric practice. Pediatr Radiol. 2019;49(4):458-68.
2. 2. Arlachov Y, Ganatra RH. Sedation/anaesthesia in paediatric radiology. Br J Radiol. 2012;85(1019):1018-31.
3. 3. Hara T, Ozawa A, Shibutani K, Tsujino K, Miyauchi Y, Kawano T, et al. Working Group for the Preparation of Practical Guideli-nes for Safe Sedation, Safety Committee of the Japanese Soci-ety of Anesthesiologists. Practical guide for safe sedation. J Anesth. 2023;37(3):340-56.
4. 4. Zielinska M, Bartkowska-Sniatkowska A, Becke K, Höhne C, Najafi N, Schaffrath E, et al. Safe pediatric procedural sedation and analgesia by anesthesiologists for elective procedures: A clinical practice statement from the European Society for Pae-diatric Anaesthesiology. Pediatr Anaesth 2019;29(6):583-90.
5. 5. Schulte-Uentrop L, Goepfert MS. Anaesthesia or sedation for MRI in children. Curr Opin Anesthesiol. 2010;23(4):513-7.
6. 6. Kannikeswaran N, Chen X, Sethuraman U. Utility of endtidal carbon dioxide monitoring in detection of hypoxia during se-dation for brain magnetic resonance imaging in children with developmental disabilities. Pediatr Anaesth. 2011;21(12):1241-6.
7. 7. Zhou Q, Shen L, Zhang X, Li J, Tang Y. Dexmedetomidine versus propofol on the sedation of pediatric patients during magnetic resonance imaging (MRI) scanning: a meta-analysis of current studies. Oncotarget. 2017;8(60):102468-73.
8. 8. Dalens BJ, Pinard AM, Létourneau DR, Albert NT, Truchon RJ. Prevention of emergence agitation after sevoflurane anesthe-sia for pediatric cerebral magnetic resonance imaging by small doses of ketamine or nalbuphine administered just before dis-continuing anesthesia. Anesth Analg. 2006;102(4):1056-61.

9. 9. Boriosi JP, Eickhoff JC, Hollman GA. Safety and efficacy of buc-cal dexmedetomidine for MRI sedation in school-aged child-ren. Hosp Pediatr. 2019;9(5):348-54.
10. 10. Oğurlu M, Orhan ME, Bilgin F, Sizlan A, Yanarateş O, Yilmaz N. Efficacy of different concentrations of sevoflurane administe-red through a face mask for magnetic resonance imaging in children. Pediatr Anaesth. 2010;20(12):1098-104.
11. 11. Weldon BC, Bell M, Craddock T. The effect of caudal analgesia on emergence agitation in children after sevoflurane versus halothane anesthesia. Anesth Analg. 2004;98(2):321-6.
12. 12. Kol IO, Egilmez H, Kaygusuz K, Gursoy S, Mimaroglu C. Open-label, prospective, randomized comparison of propofol and se-voflurane for laryngeal mask anesthesia for magnetic resonance imaging in pediatric patients. Clin Ther. 2008;30(1):175-81.
13. 13. Malviya S, Voepel-Lewis T, Eldevik OP, Rockwell DT, Wong JH, Tait AR. Sedation and general anaesthesia in children undergo-ing MRI and CT: adverse events and outcomes. Br J Anaesth. 2000;84(6):743-8.
14. 14. Dalal PG, Murray D, Cox T, McAllister J, Snider R. Sedation and anesthesia protocols used for magnetic resonance imaging stu-dies in infants: provider and pharmacologic considerations. Anesth Analg. 2006;103(4):863-8.
15. 15. Machata AM, Willschke H, Kabon B, Kettner SC, Marhofer P. Propofol-based sedation regimen for infants and children un-dergoing ambulatory magnetic resonance imaging. Br J Ana-esth. 2008;101(2):239-43.
16. 16. Sahinovic MM, Struys MMRF, Absalom AR. Clinical pharmacoki-netics and pharmacodynamics of propofol. Clin Pharmacokinet. 2018;57(12):1539-1558.
17. 17. Atalay YO, Leman T, Tobias JD. Efficacy and safety of intrave-nous thiopental for sedation during magnetic resonance ima-ging in pediatric patients: a retrospective analysis. Saudi J Ana-esth. 2017;11(2):185.
18. 18. Bloomfield EL, Masaryk TJ, Caplin A, Obuchowski NA, Schubert A, Hayden J, et al. Intravenous sedation for MR imaging of the brain and spine in children: pentobarbital versus propofol. Ra-diology. 1993;186(1):93-7.
19. 19. De Sanctis Briggs V. Magnetic resonance imaging under seda-tion in newborns and infants: a study of 640 cases using sevof-lurane. Pediatr Anaesth. 2005;15(1):9-15.
20. 20. Ustun YB, Atalay YO, Koksal E, Kaya C, Ozkan F, Sener EB, et al. Thiopental versus ketofol in paediatric sedation for magnetic resonance imaging: a randomized trial. J Pak Med Assoc. 2017;67(2).
21. 21. Russo H, Bressolle F. Pharmacodynamics and pharmacokinetics of thiopental. Clin Pharmacokinet. 1998;35(2):95-134.
22. 22. Adaş C, Adaş H, Ergun G, Aydın N, Kurt N, Gül F, et al. Compari-son of comfort, recovery and discharge times of sodium thio-pental and propofol anesthesia in pediatric patients who un-derwent outpatient anesthesia for magnetic resonance ima-ging. J Kartal TR. 2013;24(1):1–5.
23. 23. Mongodi S, Ottonello G, Viggiano R, Borrelli P, Orcesi S, Pic-hiecchio A, et al. Ten-year experience with standardized non-operating room anesthesia with sevoflurane for MRI in child-ren affected by neuropsychiatric disorders. BMC Anesthesiol. 2019;19(1):235.
24. 24. Lei H, Chao L, Miao T, Shen Ling L, Yan Ying P, Xiao Han P, et al. Serious airway‐related adverse events with sevoflurane anest-hesia via facemask for magnetic resonance imaging in 7129 pediatric patients: a retrospective study. Von Ungern‐Sternberg B, editor. Pediatr Anaesth. 2019;29(6):635-9.
25. 25. Trapani G, Altomare C, Liso G, Sanna E, Biggio G. Propofol in anesthesia. Mechanism of action, structure-activity relations-hips, and drug delivery. Curr Med Chem. 2000;7(2):249-71.
26. 26. Michel F, Constantin JM. Sevoflurane inside and outside the operating room. Expert Opin Pharmacother. 2009;10(5):861-73.
27. 27. Alp H, Orbak Z, Güler I, Altinkaynak S. Efficacy and safety of rectal thiopental, intramuscular cocktail and rectal midazolam for sedation in children undergoing neuroimaging. Pediatr Int. 2002;44(6):628-34.