title: Procedural sedation for MRI in children with ADHD.
abstract: BACKGROUND
  Attention-deficit hyperactivity disorder (ADHD) is the most common neurobehavioral disorder of childhood, affecting 5-8% of children. It has been observed that these children have poor sedation experiences; however, to date there is minimal research on procedural sedation in this population.
  
  
  OBJECTIVE
  To examine whether children with ADHD required larger doses of propofol for magnetic resonance imaging (MRI) sedation.
  
  
  METHODS
  The hospital's administrative billing database was used to identify all billing codes for MRI brain scans (with and without contrast) in children aged between 5 and 12 years over the preceding 5.5 years. The hospital's electronic medical record database provided baseline demographics. The sedation record was reviewed for propofol dose, psychostimulant use, and prescribed dose. All children received a standard weight-based dose of midazolam prior to receiving the necessary amount of propofol. Primary outcome was the dose of propofol administered (mg·kg(-1) ) to achieve adequate sedation.
  
  
  RESULTS
  A total of 258 procedures met the inclusion criteria. The sample was 52% male, 74% White, 7.8% Black, 7.8% Hispanic, 4.3% Asian, and 6.2% other. ADHD was documented for 49 procedures with a prevalence of 18.5%. Patients with ADHD were older, more likely to be male, Hispanic, or to report race as 'Refused/Unknown'. Indications for MRI for patients with ADHD varied significantly, with 'Behavioral' and 'Neurocutaneous' being significantly overrepresented in the ADHD group. The average sedative dose for all patients was 2.8 mg·kg(-1) (95% CI 2.62-2.94). Sedative dose was similar among children with and without ADHD diagnosis.
  
  
  CONCLUSIONS
  Our study illustrates that children with ADHD do not have higher sedative requirements to achieve a successful brain MRI.
authors.affiliation: Department of Medicine-Pediatrics, Baystate Medical Center, Springfield, MA, USA.|Department of Medicine and Department of Pediatrics, Tufts University School of Medicine, Boston, MA, USA.
authors.forename: Eimear
authors.initials: E
authors.lastname: Kitt
authors.affiliation: Department of Medicine and Department of Pediatrics, Tufts University School of Medicine, Boston, MA, USA.|Department of Medicine, Baystate Medical Center, Springfield, MA, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Friderici
authors.affiliation: Department of Medicine and Department of Pediatrics, Tufts University School of Medicine, Boston, MA, USA.|Department of Medicine, Baystate Medical Center, Springfield, MA, USA.
authors.forename: Reva
authors.initials: R
authors.lastname: Kleppel
authors.affiliation: Department of Medicine and Department of Pediatrics, Tufts University School of Medicine, Boston, MA, USA.|Department of Pediatric Critical Care, Baystate Medical Center, Springfield, MA, USA.|Department of Pediatric Critical Care, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Canarie
mesh_terms: D018686:Anesthetics, Intravenous / Q000494:pharmacology*; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D015742:Propofol / Q000494:pharmacology*
chemical_list: D018686:Anesthetics, Intravenous; D015742:Propofol
keywords: Attention-deficit hyperactivity disorder; child; humans; hypnotics and sedatives; midazolam; propofol