A comparison of dexmedetomidine with propofol for magnetic resonance imaging sleep studies in children

Abstract

Background: Magnetic resonance imaging (MRI) sleep studies can be used to guide management of children with obstructive sleep apnea (OSA) refractory to conservative therapy. Because children with OSA are sensitive to the respiratory-depressant effects of sedatives and anesthetics, provision of anesthesia for imaging studies in this patient population can be challenging. Dexmedetomidine has been shown to have pharmacological properties simulating natural sleep with minimal respiratory depression. We hypothesized that, compared with propofol, dexmedetomidine would have less effect on upper airway tone and airway collapsibility, provide more favorable conditions during dynamic MRI airway imaging in children with OSA, have fewer scan interruptions, and require less aggressive airway interventions.

Methods: In this retrospective descriptive study, we reviewed the records of 52 children receiving dexmedetomidine and 30 children receiving propofol for anesthesia during MRI sleep studies between July 2006 and March 2008. Documentation of the severity of OSA by overnight polysomnography was available for 67 of the 82 subjects, who were analyzed separately. Data analyzed included demographics, severity of OSA, comorbidities, hemodynamic changes, use of artificial airways, additional airway maneuvers, and successful completion of the MRI scan.

Results: Demographics, OSA severity by polysomnography, anesthetic induction, and baseline hemodynamics were comparable in both groups. An interpretable MRI sleep study was obtained for 98% of children in the dexmedetomidine group and 100% in the propofol group. Of 82 children, MRI sleep studies were successfully completed without the use of artificial airways in 46 children (88.5%) in the dexmedetomidine group versus 21 children (70%) in the propofol group (P = 0.03). An artificial airway was required to complete the study in five children (12%) in the dexmedetomidine group versus nine children (35%) in the propofol group (P = 0.06). Additional airway maneuvers (chin lift and shoulder roll) were required to complete the study in one child (2%) in the dexmedetomidine group and three children (10%) in the propofol group (P = 0.14). Children in the dexmedetomidine group experienced reductions in heart rate, whereas those in the propofol group experienced reductions in arterial blood pressure; these reductions were statistically, but not clinically, significant.

Conclusions: Dexmedetomidine provided an acceptable level of anesthesia for MRI sleep studies in children with OSA, producing a high yield of interpretable studies of the patient's native airway. The need for artificial airway support during the MRI sleep study was significantly less with dexmedetomidine than with propofol. Dexmedetomidine may be the preferred drug for anesthesia during MRI sleep studies in children with a history of severe OSA and may offer benefits to children with sleep-disordered breathing requiring anesthesia or anesthesia for other diagnostic imaging studies.