A comparison of the use of propofol alone and propofol with midazolam for pediatric magnetic resonance imaging sedation \u2013 a retrospective cohort study

Ryunga Kang,Ki Yoon Kim,Ji Seon Jeong,Nam-Su Gil,Hyean Yeo,Young Hee Shin

doi:10.1186/s12871-017-0431-2

Abstract

BackgroundPediatric MRI sedation performed by a variety of specialists such as sedationists and anesthesiologists commonly uses propofol, which has similar effects to an ideal sedative agent for maintaining deep sedation. However, when propofol is used, adverse airway events are relatively more common than when using other sedative agents. The concomitant administration of midazolam and propofol can reduce the dose of propofol needed for adequate sedation and might also reduce the frequency of airway obstruction without affecting the patient’s recovery profile.MethodsWe reviewed the our hospital records of all pediatric MRI sedation patients aged 3 to 16 years who were sedated with either propofol alone or propofol with midazolam between December 2013 and June 2016.ResultsEight hundred ninety-seven pediatric MRI sedation patients were included (n = 897). The frequency of airway intervention was 25/356 (7.0%) in Group P and 15/541 (2.8%) in Group PM (difference in proportions: 4.2%; 95% CI: 1.4–7.6%; p = 0.002). The mean (SD) time to awake was longer in Group PM compared to Group P [21.2 (5.6) minutes vs. 23.0 (7.1) minutes; mean difference, 1.8 min; 95% CI, 0.9–2.9; p < 0.001]. The mean (SD) time to discharge was longer in Group PM compared to Group P [34.5 (6.9) minutes vs. 38.6 (9.4) minutes; mean difference, 4.0 min; 95% CI, 3.0–5.1; p < 0.001].ConclusionsThe administration of a small dose of midazolam during pediatric MRI sedation using propofol can reduce the frequency of airway complications without prolonging the clinically significant recovery profile.

Highlights

Pediatric Magnetic resonance imaging (MRI) sedation performed by a variety of specialists such as sedationists and anesthesiologists commonly uses propofol, which has similar effects to an ideal sedative agent for maintaining deep sedation
The frequency of oral/nasal airway application was 14/356 (3.9%) in groups: those who received propofol alone (Group P) and 10/541 (1.8%) in Group PM
Data are mean ± SD or number (%) ASA American Society of Anesthesiology, MRI magnetic resonance imaging mean (SD) time to awake was longer in Group PM compared to Group P [21.2 (5.6) minutes vs. 23.0 (7.1) minutes; mean difference, 1.8 min; 95% CI, 0.9–2.9; p < 0.001]

Summary

Introduction

Pediatric MRI sedation performed by a variety of specialists such as sedationists and anesthesiologists commonly uses propofol, which has similar effects to an ideal sedative agent for maintaining deep sedation. When propofol is used, adverse airway events are relatively more common than when using other sedative agents. The concomitant administration of midazolam and propofol can reduce the dose of propofol needed for adequate sedation and might reduce the frequency of airway obstruction without affecting the patient’s recovery profile. Pediatric patients need sedation because proper cooperation is difficult to obtain. Pediatric MRI sedation performed by a variety of specialists such as sedationists and anesthesiologists commonly uses propofol, which has similar effects to an ideal sedative agent for maintaining deep sedation [4]. Adverse airway events are more common than with other sedative agents [2]

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