Deep sedation with midazolam and propofol in children undergoing ambulatory magnetic resonance imaging of the brain

Abstract

BACKROUND/AIM: Sedation is necessary in children undergoing magnetic resonance imaging (MRI) to ensure motionless. The success of sedation is typically measured by two factors: safety (lack of adverse events) and effectiveness of the procedure (successful completion of the diagnostic examination). Propofol is frequently used to induce deep sedation in children. However, increased doses of propofol may lead to oversedation and respiratory depression. The aim of the study was to investigate sedation in children using propofol with midazolam in regard to efficacy, adverse events and time to return to presedation functional status. We investigated 24 children prospectively. Sedation was introduced with a single bolus of intravenous (iv) midazolam 0.1 mg/kg followed by repeated small iv boluses of propofol until sufficient depth of sedation was obtained. The outcome of sedation was measured by the induction time, sedation time, need for additional sedation, respiratory events, cardiovascular events and sedation failure. Median age of children was 4.72 +/- 3.06 (1.1-12.3) years and their body weight was 21.3 +/- 11.9 (11-60) kg. Average propofol bolus dose for induction was 1.76 +/- 0.9 (0.5-4) mg/kg. The induction time was 8.88 +/- 2.92 (5-15) min, and sedation time 28.39 +/- 8.42 (20-50) min. Additional sedation was necessary in 3 (12.5%) patients. Unsucesfull sedation or significant adverse events were not observed. The presented sedation technique for children undergoing ambulatory MRI of the brain is safe and adequate. This sedation regiment provides short induction time, fast recovery, stable cardiorespiratory conditions and rarely demans additional sedation.