Abstract
Introduction: Utilization of magnetic resonance imaging (MRI) in children is on the rise. The majority of children require sedation for MRI. Choosing the correct drug that is short-acting, safe, and effective is important. Hypothesis: Pediatric patients receiving dexmedetomidine (DEX) for MRI sedation require additional rescue agents to maintain comparable sedation, and have longer recovery times when compared to propofol (PROP). Methods: A retrospective chart review of outpatient MRI sedations in patients aged 6 months to 21 years (ASA 1 or 2) from January to December 2011. Patients were sedated with DEX or PROP to achieve a sedation score of zero. DEX group was given IV bolus of 1.5 mcg/kg/min over 10 minutes followed by infusion at 1 mcg/kg/min. If needed, additional bolus of 0.5 mcg/kg was given to achieve sedation score of zero. PROP group were given IV bolus in 1mg/kg increments to achieve a sedation score of zero. They were then placed on an infusion of 100mcg/kg/min. The following parameters were measured: amount of rescue boluses needed to complete MRI, time to complete MRI, time to wake up, and time to discharge. Adverse events measured included bradycardia, incidence of apnea requiring BVM, and hypotension requiring IV bolus. Results: 208 charts (103 PROP, 105 DEX) were reviewed. Median age was 3.9 years. The majority of studies were brain MRI (78%). Forty five (42.9%) DEX patients required rescue boluses of PROP or midazolam to achieve a sedation score of zero. Only 9 (8.7%) PROP patients required rescue boluses of additional PROP (p<0.001). DEX patients had longer recovery times after sedation when compared to PROP patients (55 vs. 33 min, p<0.001). DEX patients took on average 20 minutes longer to be discharged after completion of MRI (p<0.001). 2 DEX patients were not able to complete MRI and required general anesthesia. All PROP patients completed MRI. There were no adverse events in either group. Conclusions: PROP provided superior sedation in regards to completion of MRI, shorter wake up times and time to discharge when compared to DEX.
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