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Dexmedetomidine versus Propofol: Is One Better Than the Other for MRI Sedation in Children?
01 December 2015
27 April 2016
24 June 2016 (online)
Objective The aim of this article is to determine whether dexmedetomidine or propofol is better for MRI sedation in children.
Design This study is a retrospective review of patients sedated with dexmedetomidine or propofol for MRI between July 2007 and July 2015. Dexmedetomidine group (group D) was administered a bolus of 2 µg/kg over 10 minutes followed by a 1 ug/kg/hour infusion. Propofol group (group P) received a bolus of 2 mg/kg over 2 minutes followed by 83 µg/kg/minute infusion.
Results Of the 996 cases completed, 452 were in group P and 544 were in group D. Patients in group P were heavier and older than those in group D. All the patients except one in group D completed the procedures. Hypotension occurred in 59% in group P versus 4% in group D (89 ± 11.4 SBP vs. 103.80 ± 19.4; p < 0.05). Bradycardia was observed in 2.9% in group P versus 0.6% in group D. Apnea occurred in two patients in group D. Although procedure time was longer in patients receiving propofol versus dexmedetomidine (58.87 ± 28.17 vs. 45 ± 23.6; p < .05), the discharge time was significantly shorter (37. ± 12.30 vs. 92.61 ± 28.19; p < 0.05).
Conclusion Dexmedetomidine appears to provide a useful alternative to propofol for MRI sedation with a longer recovery time, stable hemodynamics, and less reliable respiratory profile, while the propofol had the advantage of quicker onset and rapid recovery.
- 1 Funk W, Hörauf K, Held P, Taeger K. Anesthesia for magnetic resonance tomography in neonates, infants and young children [in German]. Radiologe 1997; 37 (2) 159-164
- 2 Kannikeswaran N, Mahajan PV, Sethuraman U, Groebe A, Chen X. Sedation medication received and adverse events related to sedation for brain MRI in children with and without developmental disabilities. Paediatr Anaesth 2009; 19 (3) 250-256
- 3 Bhana N, Goa KL, McClellan KJ. Dexmedetomidine. Drugs 2000; 59 (2) 263-268 , discussion 269–270
- 4 Shelly MP. Dexmedetomidine: a real innovation or more of the same?. Br J Anaesth 2001; 87 (5) 677-678
- 5 Nelson LE, Lu J, Guo T, Saper CB, Franks NP, Maze M. The alpha2-adrenoceptor agonist dexmedetomidine converges on an endogenous sleep-promoting pathway to exert its sedative effects. Anesthesiology 2003; 98 (2) 428-436
- 6 Koroglu A, Demirbilek S, Teksan H, Sagir O, But AK, Ersoy MO. Sedative, haemodynamic and respiratory effects of dexmedetomidine in children undergoing magnetic resonance imaging examination: preliminary results. Br J Anaesth 2005; 94 (6) 821-824
- 7 Deegan RJ. Propofol: a review of the pharmacology and applications of an intravenous anesthetic agent. Am J Med Sci 1992; 304 (1) 45-49
- 8 American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists. Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology 2002; 96 (4) 1004-1017
- 9 Coté CJ, Wilson S ; American Academy of Pediatrics; American Academy of Pediatric Dentistry; Work Group on Sedation. Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures: an update. Pediatrics 2006; 118 (6) 2587-2602
- 10 Aldrete JA, Kroulik D. A postanesthetic recovery score. Anesth Analg 1970; 49 (6) 924-934
- 11 Heard C, Burrows F, Johnson K, Joshi P, Houck J, Lerman J. A comparison of dexmedetomidine-midazolam with propofol for maintenance of anesthesia in children undergoing magnetic resonance imaging. Anesth Analg 2008; 107 (6) 1832-1839
- 12 Schulte-Tamburen AM, Scheier J, Briegel J, Schwender D, Peter K. Comparison of five sedation scoring systems by means of auditory evoked potentials. Intensive Care Med 1999; 25 (4) 377-382
- 13 Malviya S, Voepel-Lewis T, Eldevik OP, Rockwell DT, Wong JH, Tait AR. Sedation and general anaesthesia in children undergoing MRI and CT: adverse events and outcomes. Br J Anaesth 2000; 84 (6) 743-748
- 14 Voepel-Lewis T, Malviya S, Prochaska G, Tait AR. Sedation failures in children undergoing MRI and CT: is temperament a factor?. Paediatr Anaesth 2000; 10 (3) 319-323
- 15 Hasan RA, Shayevitz JR, Patel V. Deep sedation with propofol for children undergoing ambulatory magnetic resonance imaging of the brain: experience from a pediatric intensive care unit. Pediatr Crit Care Med 2003; 4 (4) 454-458
- 16 Ebert TJ, Muzi M, Berens R, Goff D, Kampine JP. Sympathetic responses to induction of anesthesia in humans with propofol or etomidate. Anesthesiology 1992; 76 (5) 725-733
- 17 Ebert TJ, Hall JE, Barney JA, Uhrich TD, Colinco MD. The effects of increasing plasma concentrations of dexmedetomidine in humans. Anesthesiology 2000; 93 (2) 382-394
- 18 Talke P, Chen R, Thomas B , et al. The hemodynamic and adrenergic effects of perioperative dexmedetomidine infusion after vascular surgery. Anesth Analg 2000; 90 (4) 834-839
- 19 Aantaa R. Assessment of the sedative effects of dexmedetomidine, an alpha 2-adrenoceptor agonist, with analysis of saccadic eye movements. Pharmacol Toxicol 1991; 68 (5) 394-398
- 20 Bloor BC, Ward DS, Belleville JP, Maze M. Effects of intravenous dexmedetomidine in humans. II. Hemodynamic changes. Anesthesiology 1992; 77 (6) 1134-1142
- 21 Mason KP, Zurakowski D, Zgleszewski SE , et al. High dose dexmedetomidine as the sole sedative for pediatric MRI. Paediatr Anaesth 2008; 18 (5) 403-411
- 22 Berkenbosch JW, Wankum PC, Tobias JD. Prospective evaluation of dexmedetomidine for noninvasive procedural sedation in children. Pediatr Crit Care Med 2005; 6 (4) 435-439 , quiz 440
- 23 Tecanivate A, Verawattagnon T, Saiyuenyong C, Areeruk P. A comparison of dexmedetomidine versus propofol on hypotension during colonoscopy under sedation. J Anesth Clin Res 2012; 3: 257
- 24 Arain SR, Ebert TJ. The efficacy, side effects, and recovery characteristics of dexmedetomidine versus propofol when used for intraoperative sedation. Anesth Analg 2002; 95 (2) 461-466
- 25 Heard CM, Joshi P, Johnson K. Dexmedetomidine for pediatric MRI sedation: a review of a series of cases. Paediatr Anaesth 2007; 17 (9) 888-892
- 26 Wu J, Mahmoud M, Schmitt M, Hossain M, Kurth D. Comparison of propofol and dexmedetomedine techniques in children undergoing magnetic resonance imaging. Paediatr Anaesth 2014; 24 (8) 813-818
- 27 Lubisch N, Roskos R, Berkenbosch JW. Dexmedetomidine for procedural sedation in children with autism and other behavior disorders. Pediatr Neurol 2009; 41 (2) 88-94
- 28 Pershad J, Wan J, Anghelescu DL. Comparison of propofol with pentobarbital/midazolam/fentanyl sedation for magnetic resonance imaging of the brain in children. Pediatrics 2007; 120 (3) e629-e636
- 29 Koroglu A, Teksan H, Sagir O, Yucel A, Toprak HI, Ersoy OM. A comparison of the sedative, hemodynamic, and respiratory effects of dexmedetomidine and propofol in children undergoing magnetic resonance imaging. Anesth Analg 2006; 103 (1) 63-67
- 30 Cravero JP, Blike GT, Beach M , et al; Pediatric Sedation Research Consortium. Incidence and nature of adverse events during pediatric sedation/anesthesia for procedures outside the operating room: report from the Pediatric Sedation Research Consortium. Pediatrics 2006; 118 (3) 1087-1096