Timeliness of care and adverse event profile in children undergoing general anesthesia or sedation for MRI: An observational prospective cohort study

Abstract

Background and aims: Anaesthesia for children undergoing magnetic resonance imaging (MRI) ranges from moderate to deep sedation in order to facilitate uninterrupted completion of the scan. While various intravenous and inhalational techniques of anaesthesia have their own merits and demerits, there is a paucity of comparative literature between the two in children undergoing diagnostic MRI.

Materials and methods: This prospective observational cohort study was conducted at the Radiology suite of a 2800-bedded tertiary care hospital, wherein 107 unpremedicated children between the ages of 6 months to 15 years received either sedation with propofol infusion (Group GSP, n = 57) or inhalational anaesthesia with a laryngeal mask airway (Group GAL, n = 50). Primary outcome measures included time to induction and time to recovery. Secondary outcomes comprised the incidence of respiratory and non-respiratory adverse events in the two groups.

Results: The median time to induction was significantly shorter in GSP than GAL [7.00 (IQR 5.0, 10.0) versus 10.00 minutes (IQR 8.8, 13.0), P < 0.001]; the incidence of desaturation [8 (16.0%) in GAL, 1 (1.8%) in GSP, P = 0.012], laryngospasm [11 (22.4%) in GAL, 1 (1.8%) in GSP, P = 0.001] and emergence delirium (5 (10%) in GAL, 0 in GSP, P = 0.047) were significantly greater in the GAL group. There was no difference in the time to emergence, nausea and vomiting or bradycardia between the two groups.

Conclusion: Sedation with propofol infusion during paediatric MRI scan offers a short turnover time and favourable adverse event profile when compared to inhalational anaesthesia with an LMA.

Keywords: Anaesthesia recovery period; cohort analysis; general anaesthesia; inhalational anaesthesia; magnetic resonance imaging; propofol.

Figure 1

(a) Box plot depicting the median time to induction in the general anaesthesia (GAL) and propofol sedation (GSP) groups [10.0 minutes (IQR 8.8, 13.0) versus 7 minutes (IQR 5.0, 10.0), P < 0.001) respectively. (b) Box plot showing the median time to recovery in the GAL and GSP groups (20.0 minutes (IQR 10.0, 31.3), P value 0.13) versus 25.0 minutes (IQR 15.0, 40.0)