Comparison of propofol with pentobarbital/midazolam/fentanyl sedation for magnetic resonance imaging of the brain in children.
OBJECTIVE
Propofol and pentobarbital, alone or combined with other agents, are frequently used to induce deep sedation in children for MRI. However, we are unaware of a previous comparison of these 2 agents as part of a randomized, controlled trial. We compared the recovery time of children after deep sedation with single-agent propofol with a pentobarbital-based regimen for MRI and considered additional variables of safety and efficacy.


METHODS
This prospective, randomized trial at a tertiary children's hospital enrolled 60 patients 1 to 17 years old who required intravenous sedation for elective cranial MRI. Patients were assigned randomly to receive a loading dose of propofol followed by continuous intravenous infusion of propofol or to receive sequential doses of midazolam, pentobarbital, and fentanyl until a modified Ramsay score of >4 was attained. A nurse who was blind to group assignment assessed discharge readiness (Aldrete score > 8) and administered a follow-up questionnaire. We compared recovery time, time to induction of sedation, total sedation time, quality of imaging, number of repeat-image sequences, adverse events, caregiver satisfaction, and time to return to presedation functional status.


RESULTS
The groups were similar in age, gender, race, American Society of Anesthesiology physical status class, and frequency of cognitive impairment. No sedation failure or significant adverse events were observed. Propofol offered significantly shorter sedation induction time, recovery time, total sedation time, and time to return to baseline functional status. Caregiver satisfaction scores were also significantly higher in the patients in the propofol group.


CONCLUSIONS
Propofol permits faster onset and recovery than, and comparable efficacy to, a pentobarbital/midazolam/fentanyl regimen for sedation of children for MRI.
Pershad
Jay
J
Division of Emergency Medicine, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN 38103, USA. pers2260@bellsouth.net
Wan
Jim
J
Anghelescu
Doralina L
DL
D000759:Adjuvants, Anesthesia / Q000627:therapeutic use; D000293:Adolescent; D000762:Anesthesia Recovery Period; D001921:Brain / Q000473:pathology*; D017028:Caregivers; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007223:Infant; D007262:Infusions, Intravenous; D008279:Magnetic Resonance Imaging; D008297:Male; D008874:Midazolam / Q000627:therapeutic use; D017060:Patient Satisfaction; D010424:Pentobarbital / Q000627:therapeutic use; D015742:Propofol / Q000627:therapeutic use; D011446:Prospective Studies; D016896:Treatment Outcome
D000759:Adjuvants, Anesthesia; D006993:Hypnotics and Sedatives; D010424:Pentobarbital; D008874:Midazolam; D005283:Fentanyl; D015742:Propofol