Sedation and anesthesia protocols used for magnetic resonance imaging studies in infants: provider and pharmacologic considerations.
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).
Dalal
Priti G
PG
Department of Anesthesiology, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri 63110, USA. pgdalal@hotmail.com
Murray
David
D
Cox
Thomas
T
McAllister
John
J
Snider
Rebecca
R
D000284:Administration, Oral; D000768:Anesthesia, General / Q000009:adverse effects / Q000379:methods*; D000776:Anesthesiology / Q000592:standards*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000009:adverse effects; D002697:Chloral Hydrate / Q000008:administration & dosage / Q000009:adverse effects; D016292:Procedural Sedation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000009:adverse effects; D007223:Infant; D007262:Infusions, Intravenous; D008279:Magnetic Resonance Imaging / Q000379:methods*; D009719:Nurse Anesthetists; D010424:Pentobarbital / Q000008:administration & dosage / Q000009:adverse effects; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects; D012189:Retrospective Studies; D000078329:Workforce
D018686:Anesthetics, Intravenous; D006993:Hypnotics and Sedatives; D002697:Chloral Hydrate; D010424:Pentobarbital; D015742:Propofol