Propofol-based sedation regimen for infants and children undergoing ambulatory magnetic resonance imaging

Abstract

BackgroundPropofol is widely used for infants and children requiring sedation for magnetic resonance imaging. However, increased doses of propofol may quickly lead to an unintended deep sedation and respiratory depression. Thus, an appropriate low dosage, which nevertheless ensures sufficient sleep for successful magnetic resonance imaging (MRI) completion, would probably minimize respiratory adverse events. We investigated the safety and efficacy of a low-dose propofol-based sedation regimen in a broad age range of children. MethodsWe investigated 500 infants and children, prospectively. Premedication consisted of i.v. midazolam 0.1 mg kg−1. Sedation was induced with i.v. nalbuphine 0.1 mg kg−1 and propofol 1 mg kg−1, and maintained with propofol 5 mg kg−1 h−1. Outcome measures were induction time, sedation time, recovery time, need for additional sedation, respiratory events, cardiovascular events, paradoxical reactions, and sedation failure. ResultsData were obtained from 53 infants and 447 children. Median (IQR) age was 5.3 (4.5, 6.1) yr and body weight was 19.3 (16.5, 24.7) kg. The induction time was 2 (1, 2) min, sedation time 55 (45, 65) min, and recovery time 8 (8, 9) min. Additional sedation was necessary in 11 patients (2.2%), mild respiratory events occurred in five patients (1%). All MRI examinations could be completed without paradoxical reaction or sedation failure. ConclusionThis sedation regimen provides the shortest induction time so far described, a rare demand for additional sedation, a low incidence of respiratory events, and a rapid recovery.