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Sedation and monitoring of paediatric patients undergoing open low-field MRI
T Rupprecht1, R Kuth, B Bowing
1Klinik für Kinder und Jugendliche, Universität Erlangen-Nürnberg, Erlangen, Germany. thomas.rupprecht@kinder.med.uni-erlangen.de
Insights
Open MRI systems require significantly less sedation for pediatric patients compared to closed systems. This study found midazolam and etomidate combination safe and effective for pediatric MRI sedation.
Area of Science:
- Pediatric Radiology
- Medical Imaging Technology
Background:
- Sedation and monitoring are crucial for pediatric Magnetic Resonance Imaging (MRI) in closed, high-field systems.
- Open MRI systems offer potential advantages for pediatric imaging but require evaluation of sedation and monitoring protocols.
Purpose of the Study:
- To assess the necessity, efficacy, and safety of sedation and monitoring for pediatric patients undergoing MRI in an open, low-field system.
- To compare sedation rates in open low-field MRI versus traditional closed high-field MRI.
Main Methods:
- Evaluated 274 pediatric patients (median age 9 years) in an open, low-field MRI.
- Administered intravenous midazolam (0.2 mg/kg) and etomidate (0.2 mg/kg) for sedation when needed.
- Monitored oxygen saturation, arterial blood pressure, and ECG, adapting equipment for high-frequency shielding.
Main Results:
- Only 27% of children required sedation in the open MRI, significantly lower than the 47% in a control high-field group (p < 0.0001).
- Sedation was effective and safe using midazolam and etomidate, with no serious side effects.
- No significant movement artifacts occurred, and general anesthesia was avoided in all cases.
Conclusions:
- Open MRI systems facilitate pediatric imaging with reduced sedation needs compared to closed high-field systems.
- The midazolam and etomidate combination is a safe and effective sedation strategy for pediatric MRI.
- Modifications to monitoring equipment may be necessary for low-field MRI systems, and dedicated pediatric open MRI units are advantageous.
Unlabelled:
The purpose of this study was to determine the need, effectiveness and safety of sedation and monitoring in infants and children in a paediatric open low-field MRI system. Of 274 patients (median age 9 y) examined, only 74 children (median age 25 mo) needed sedation. Sedation was achieved by intravenous administration of midazolam (0.2 mg/kg) and etomidate (0.2 mg/kg). Mean total doses required were 0.28 and 0.27 mgl/kg, respectively. With the exception of eight primarily ventilated patients, all children breathed spontaneously. O2 saturation, arterial blood pressure and ECG were monitored. The low resonance frequency of the MRI system required a specially designed high frequency (HF) shielding of the monitor system to avoid HF artifacts. The overall sedation rate was markedly lower (74/274 = 27%) compared to a control group previously examined in a closed high-field MRI system (52/111 = 47%). This was due to a significant lower need for sedation in patients aged up to 10 y (p < or = 0.0001) in the open MRI unit. General anaesthesia could be avoided in all patients. No significant movement artifacts occurred in any of the MRI examinations and no serious side effects were observed.
Conclusions:
MRI of children is easier in an open MRI system and with fewer sedations, as in closed high-field systems. Sedation by a combination of midazolam and etomidate is highly effective and safe. Monitoring devices for high-field systems may have to be modified for low-field systems. An in-house paediatric MRI unit with an open and special paediatric design is of major advantage for imaging paediatric patients.