Abstract
BackgroundMagnetic resonance imaging (MRI) requires complete immobility of the subject during the acquisition of each sequence, which is highly important for image quality. MRI may necessitate sedation, particularly in young children and in some adolescent and adult patients, although the ideal sedation procedure leading to minimal side effects with the highest patient comfort in children undergoing MRI procedures remains controversial. The aim of this study was to compare the effects of midazolam-ketamine and midazolam-propofol combinations on hemodynamic stability, patient comfort, and post-anesthesia recovery in pediatric patients undergoing sedation for MRI and also to determine the ideal sedation procedure with minimal side effects.Materials and MethodsThe retrospective study included 40 pediatric patients aged between 2 and 12 years with normal growth and an American Society of Anesthesiology physical status (ASA-PS) 1-2 who were sedated with a combination of midazolam-ketamin or midazolam-propofol for the MRI procedure. The 40 patients were divided into two groups based on the drug combination used for sedation: (I) midazolam-ketamine (M-K) (n = 20) and (II) midazolam-propofol (M-P) (n = 20). Demographic characteristics, duration of MRI procedure, total duration of procedure, MRI image quality, family satisfaction, peripheral capillary oxygen saturation (SpO2), systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and Ramsay Sedation Score (RSS) scores were compared between the two groups.ResultsNo significant difference was detected between the groups with regard to gender, duration of MRI procedure, and total duration of procedure. The MRI scanning quality was very good in 14 (70%) and moderately good in 6 (30%) subjects in the M-K group, whereas the scanning quality was very good in 9 (45%) and moderately good in 11 (55%) subjects in the M-P group. There were significant differences between the two groups at different times in terms of SBP, DBP, and HR values. No complication was observed in any patient and no patient required additional sedation throughout the procedure.ConclusionThe midazolam-ketamine combination provided better hemodynamic stability than the midazolam-propofol combination, although the two combinations were similar with regard to patient comfort and post-anesthesia recovery.
Highlights
Magnetic resonance imaging (MRI) requires complete immobility of the subject during the acquisition of each sequence, which is highly important for image quality
The midazolam-ketamine combination provided better hemodynamic stability than the midazolam-propofol combination, the two combinations were similar with regard to patient comfort and post-anesthesia recovery
The two groups were similar in terms of age, body weight, height, duration of MRI procedure, total duration of procedure, American Society of Anesthesiologists (ASA) status, MRI scanning quality, family satisfaction, and Ramsay Sedation Score (RSS) scores (p > 0.05)
Summary
Magnetic resonance imaging (MRI) requires complete immobility of the subject during the acquisition of each sequence, which is highly important for image quality. MRI requires complete immobility of the subject during the acquisition of each sequence It may necessitate sedation, in young children and in some adolescent and adult patients, as it is a semienclosed environment and has a long duration of operation and a high ambient noise level of up to 95 decibels (Kang et al 2017). Disabled children do not require higher doses of sedation compared to nondisabled children, they have a three-time higher risk of hypoxia under sedation (Schulte-Uentrop and Matthias 2010) These notions are of paramount importance for the patients undergoing sedation for MRI. The ultimate objective in the sedation undertaken in patients undergoing MRI procedures should be to ensure maximum patient safety, successful screening, and excellent image quality throughout the procedure
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