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. 2023 Apr;57(4):1106-1113.
doi: 10.1002/jmri.28392. Epub 2022 Aug 12.

Pediatric Sedation/Anesthesia for MRI: Results From the Pediatric Sedation Research Consortium

Michael D Mallory  1   2 , Curtis Travers  2 , Joseph P Cravero  3 , Pradip P Kamat  4 , Daniel Tsze  5 , James H Hertzog  6
Affiliations

Pediatric Sedation/Anesthesia for MRI: Results From the Pediatric Sedation Research Consortium

Michael D Mallory et al. J Magn Reson Imaging. 2023 Apr.

Abstract

Background: Magnetic resonance imaging (MRI) is the most common imaging procedure requiring sedation/anesthesia in children. Understanding adverse events associated with sedation/anesthesia is important in making decisions regarding MRI vs. other imaging modalities. No large studies have evaluated the practice of pediatric sedation/anesthesia for MRI by a variety of pediatric specialists.

Purpose: Utilize a large pediatric sedation database to characterize the patients and adverse events associated with sedation/anesthesia for pediatric MRI.

Study type: Retrospective analysis of prospectively collected data.

Subjects: The Pediatric Sedation Research Consortium (PSRC) has 109,947 entries for sedations for MRI from November 10, 2011 through December 18, 2017.

Assessment: Patient demographics, sedative medications, interventions, and adverse events are described. Associations with adverse events were assessed. Trends in sedative medications used over time are examined.

Statistical tests: Descriptive statistics, Chi-Squared and Fisher's Exact tests for categorical variables, logistic regression and assessment of trend using logistic regression and other method.

Results: A total of 109,947 MRI-related sedations were examined. Most subjects (66.2%) were 5 years old or younger. Seizure or other neurologic issue prompted MRI in 63.7% of cases. Providers responsible for sedation/anesthesia included intensivists (49.3%), emergency medicine physicians (28.2%), hospitalists (10.2%), and anesthesiologists (9.8%). The most commonly used sedative agent was propofol (89.1%). The most common airway intervention was supplemental oxygen (71.7%), followed by head/airway repositioning (20.6%). Airway-related adverse events occurred in 8.4% of patients. Serious adverse events occurred in only 0.06% of patients, including three cases of cardiac arrest. No mortality was recorded. There was a statistically significant increase in the use of dexmedetomidine over time.

Data conclusions: Overall, adverse event rates were low. Sedation/anesthesia with propofol infusion and natural airway was the most common method used by this varied group of sedation providers. The use of dexmedetomidine increased over time.

Evidence level: 4 TECHNICAL EFFICACY: Stage 5.

Keywords: adverse events; magnetic resonance imaging; pediatrics; sedation.

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References

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    1. Callahan MJ, MacDougall RD, Bixby SD, Voss SD, Robertson RL, Cravero JP. Ionizing radiation from computed tomography versus anesthesia for magnetic resonance imaging in infants and children: Patient safety considerations. Pediatr Radiol 2018;48(1):21-30.
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