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

• Published in: Anesthesia and analgesia Vol. 103; no. 4; pp. 863 - 868
• Main Authors: Dalal, Priti G., Murray, David, Cox, Thomas, McAllister, John, Snider, Rebecca
• Format: Journal Article
• Language: English
• Published: United States International Anesthesia Research Society 01-10-2006
• Subjects: Administration, Oral; Anesthesia, General - adverse effects; Anesthesia, General - methods; Anesthesiology - manpower; Anesthesiology - standards; Anesthetics, Intravenous - administration & dosage; Anesthetics, Intravenous - adverse effects; Chloral Hydrate - administration & dosage; Chloral Hydrate - adverse effects; Conscious Sedation - adverse effects; Conscious Sedation - methods; Humans; Hypnotics and Sedatives - administration & dosage; Hypnotics and Sedatives - adverse effects; Infant; Infusions, Intravenous; Magnetic Resonance Imaging - methods; Nurse Anesthetists; Pentobarbital - administration & dosage; Pentobarbital - adverse effects; Propofol - administration & dosage; Propofol - adverse effects; Retrospective Studies
• ISSN: 0003-2999; 1526-7598
• DOI: 10.1213/01.ane.0000237311.15294.0e

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).