Magnetic Resonance Imaging under Sedation in Pediatric Patients: A Single-Institution Experience

Abstract

Magnetic resonance imaging (MRI) scans for children are a challenge for anesthesiologists since the child must be sedated enough to stand still. But anesthetic drugs used for sedation might have serious side effects and monitorization resources and accessibility to the patient during MRI scan is limited. We retrospectively examined 977 pediatric patients' files who had MRI scans in our hospital. We observed that children received one of the four combinations of anesthetic drugs: group 1 received midazolam, propofol, and ketamine; group 2 received midazolam and ketamine; group 3 received midazolam and thiopental; and group 4 received midazolam and propofol combination for sedation. The patients in group 1 had significantly higher vomiting rates than the patients in group 4 (p = 0.005). We observed bronchospasm in patients in group 1 (p = 0.006) and group 3 (p = 0.001), more than in patients in group 4. Nausea and vomiting ratios were lower in group 4. In patients with nausea and vomiting within a week after the procedure, statistically significant lower neutrophil–lymphocyte ratio values (p = 0.012) were observed. All four anesthetic combinations used in the trial provided safe anesthesia for the children, during the MRI scan. The anesthetic choice must be made according to the procedure time and patient's comorbidities. In this trial, we observed minimum side effects with midazolam and propofol combination.

Keywords

magnetic resonance imaging - anesthesia - pediatric patients - neutrophil–lymphocyte ratio

Publikationsverlauf

Eingereicht: 07. Januar 2021

Angenommen: 07. Mai 2021

Artikel online veröffentlicht:
23. Juli 2021

• References

• 1 MacManus B. Trained nurses can provide safe and effective sedation of MRI in pediatric patients. Can J Anaesth 2000; 47 (03) 197-200
• 2 Uentrop LS, Goepfert MS. Anaesthesia or sedation for MRI in children. Curr Opin Anaesthesiol 2010; 23 (04) 513-517
• 3 Meléndez JC, McCrank E. Anxiety-related reactions associated with magnetic resonance imaging examinations. JAMA 1993; 270 (06) 745-747
• 4 Perez M, Cuscaden C, Somers JF. et al. Easing anxiety in preparation for pediatric magnetic resonance imaging: a pilot study using animal-assisted therapy. Pediatr Radiol 2019; 49 (08) 1000-1009
• 5 Morgan & Mikhail's Clinical Anesthesiology. 5th edition. New York: Lange; 2017: 175-188
• 6 Coté CJ, Wilson S. American Academy of Pediatrics, American Academy of Pediatric Dentistry. Guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures: update 2016. Pediatrics 2016; 138 (01) e20161212
• 7 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 (06) 2587-2602
• 8 Funk W, Hörauf K, Held P, Taeger K. [Anesthesia for magnetic resonance tomography in neonates, infants and young children]. Radiologe 1997; 37 (02) 159-164
• 9 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 (03) 250-256
• 10 Clinical anesthesiology. 5th edition. Lange, New York: 2013: 175-187
• 11 Mallory MD, Baxter AL, Kost SI. Pediatric Sedation Research Consortium. Propofol vs pentobarbital for sedation of children undergoing magnetic resonance imaging: results from the Pediatric Sedation Research Consortium. Paediatr Anaesth 2009; 19 (06) 601-611
• 12 Cravero JP, Beach ML, Blike GT, Gallagher SM, Hertzog JH. Pediatric Sedation Research Consortium. The incidence and nature of adverse events during pediatric sedation/anesthesia with propofol for procedures outside the operating room: a report from the Pediatric Sedation Research Consortium. Anesth Analg 2009; 108 (03) 795-804
• 13 Schmitz A, Weiss M, Kellenberger C. et al. Sedation for magnetic resonance imaging using propofol with or without ketamine at induction in pediatrics-a prospective randomized double-blinded study. Paediatr Anaesth 2018; 28 (03) 264-274
• 14 Yıldız AA, Demirel I, Bolat E. et al. The relationship between the preoperative neutrophil to lymphocyte ratio and postoperative nausea and vomiting in patients undergoing septorhinoplasty surgery. Aesthetic Plast Surg 2019; 43 (03) 861-865
• 15 Liu CC, Ko HJ, Liu WS. et al. Neutrophil-to-lymphocyte ratio as a predictive marker of metabolic syndrome. Medicine (Baltimore) 2019; 98 (43) e17537
• 16 Meng LB, Yu ZM, Guo P. et al. Neutrophils and neutrophil-lymphocyte ratio: Inflammatory markers associated with intimal-media thickness of atherosclerosis. Thromb Res 2018; 170: 45-52
• 17 Bahadır A, Baltacı D, Türker Y. et al. Is the neutrophil-to-lymphocyte ratio indicative of inflammatory state in patients with obesity and metabolic syndrome?. Anatol J Cardiol 2015; 15 (10) 816-822
• 18 Guthrie GJK, Charles KA, Roxburgh CSD, Horgan PG, McMillan DC, Clarke SJ. The systemic inflammation-based neutrophil-lymphocyte ratio: experience in patients with cancer. Crit Rev Oncol Hematol 2013; 88 (01) 218-230
• 19 Forget P, Khalifa C, Defour JP, Latinne D, Van Pel MC, De Kock M. What is the normal value of the neutrophil-to-lymphocyte ratio?. BMC Res Notes 2017; 10 (01) 12
• 20 Tzeng JI, Wang JJ, Ho ST, Tang CS, Liu YC, Lee SC. Dexamethasone for prophylaxis of nausea and vomiting after epidural morphine for post-Caesarean section analgesia: comparison of droperidol and saline. Br J Anaesth 2000; 85 (06) 865-868
• 21 Subramaniam B, Madan R, Sadhasivam S. et al. Dexamethasone is a cost-effective alternative to ondansetron in preventing PONV after paediatric strabismus repair. Br J Anaesth 2001; 86 (01) 84-89
• 22 Gan TJ, Diemunsch P, Habib AS. et al; Society for Ambulatory Anesthesia. Consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg 2014; 118 (01) 85-113
• 23 Ho CM, Wu HL, Ho ST, Wang JJ. Dexamethasone prevents postoperative nausea and vomiting: benefit versus risk. Acta Anaesthesiol Taiwan 2011; 49 (03) 100-104
• 24 Urits I, Orhurhu V, Jones MR. et al. Postoperative nausea and vomiting in paediatric anaesthesia. Turk J Anaesthesiol Reanim 2020; 48 (02) 88-95
• 25 Demirer Z, Karademir I, Uslu AU, Güragac A, Aksu Y. The relationship between inflammation and mean platelet volume in varicocele pathophysiology. Rev Int Androl 2018; 16 (04) 137-142
• 26 Gokdemir MT, Gokdemir GS, Taş M. The association between mean platelet volume and inflammation in geriatric patients with emergency hypertension. Turk J Emerg Med 2018; 19 (01) 16-20