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PEDIATRIC ANESTHESIA

Sedation and Anesthesia Protocols Used for Magnetic Resonance Imaging Studies in Infants: Provider and Pharmacologic Considerations

From the Department of Anesthesiology, St. Louis Children’s Hospital, Washington University School of Medicine, St. Louis, Missouri.

Address correspondence and reprint requests to Priti G. Dalal, Department of Anesthesiology, St. Louis Children’s Hospital, Washington University School of Medicine, St. Louis, MO 63110. Address e-mail to pgdalal{at}hotmail.com.

Most studies report the efficacy of only a single drug to achieve sedation in a broad age range of children. In clinical practice, a variety of sedative and anesthetic regimes are monitored by nurses and physicians. In this study we report the efficacy of a tiered approach to monitoring and sedation in infants. Two-hundred-fifty-eight infants who required magnetic resonance imaging (MRI) studies received either oral chloral hydrate (n = 102) or bolus doses of IV pentobarbital (n = 67) monitored by nurses or IV propofol infusion (n = 68) titrated by physicians. Fewer cardiorespiratory events were observed in the chloral hydrate group (2.9%) compared to pentobarbital (13.4%) and propofol groups (13.6%); P < 0.05, propofol versus chloral hydrate. Infants who received propofol were ready to begin MRI scanning earlier (mean 9.1 ± 6.7 min) than infants who received oral chloral hydrate (mean 23.5 ± 13.4 min; P < 0.05). The time to discharge was longest in the pentobarbital (mean 80.3 ± 39.2 min) and shortest in the propofol group (mean 53.9 ± 30.1 min; P < 0.05). Infants in the chloral hydrate group moved more frequently (22.5%) during MRI scanning (with four sedation failures of 102) compared to 12.2% in the pentobarbital group and 1.4% in the propofol group (P < 0.001).

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999