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Published on: July 30, 2009
Pediatric sedation in a community hospital-based outpatient MRI center
Keira P Mason1, Paulette J Fontaine, Fay Robinson
1Department of Anesthesiology, Children's Hospital Boston, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA. keira.mason@childrens.harvard.edu
Insights
Dexmedetomidine is a safe and effective option for pediatric MRI sedation in outpatient settings. This agent preserves respiration while managing hemodynamic changes, ensuring successful imaging.
Area of Science:
- Pediatric Imaging
- Sedation Pharmacology
- Outpatient Healthcare
Background:
- Increasing demand for pediatric MRI.
- Limited sedation options at community outpatient centers.
- Need for safe and effective sedation protocols.
Purpose of the Study:
- Evaluate the safety and efficacy of dexmedetomidine for pediatric MRI sedation.
- Assess outcomes in a community hospital-based outpatient setting.
- Present data on sedation success and adverse events.
Main Methods:
- Administered intravenous dexmedetomidine (3 μg/kg bolus, 1 μg/kg/hr infusion).
- Allowed repeat boluses up to two times.
- Reviewed quality assurance data for 279 children.
Main Results:
- Successfully completed all imaging studies for 279 children.
- Average sedation onset: 7.8 minutes; average imaging duration: 38.1 minutes.
- Minimal hemodynamic variability (5% HR, 33% BP deviations) requiring no pharmacologic intervention; no respiratory events.
Conclusions:
- Dexmedetomidine is a safe and effective outpatient sedation agent for pediatric MRI.
- It preserves respiration while requiring no pharmacologic intervention for hemodynamic changes.
- Offers a viable sedation option for community hospital-based centers.
Objective:
Although the demand for pediatric MRI is increasing, it is uncommon to find sedation being offered at community hospital-based outpatient centers. We present our safety, efficacy, and outcome data at a community hospital-based outpatient imaging center.
Materials And Methods:
I.v. dexmedetomidine sedation was administered as a bolus of 3 μg/kg and maintained with a continuous infusion of 1 μg/kg/hr until imaging was complete. The dexmedetomidine bolus could be repeated up to two times, if needed. Quality assurance data were reviewed.
Results:
From April 2009 to July 2010, 279 children (mean age, 4.2 years; age range, 0.2-17.2 years) were sedated. All received a first bolus, 46 required a second dose, and two received a third. The average time to achieve sedation was 7.8 minutes (SD, ± 3.8 minutes). Total duration of imaging (82% brain MRI) averaged 38.1 minutes (range, 8.0-126.0 minutes). On average, discharge criteria were met within 21.3 minutes of arrival in recovery room (± 17.8 minutes). The heart rate and blood pressure deviated from baseline by more than 20% in 5% and 33% of the patients, respectively. No pharmacologic therapy was administered to treat the hemodynamic variability. There were no adverse respiratory events. All imaging studies were successfully completed.
Conclusion:
Dexmedetomidine offers an option for pediatric sedation for MRI at community hospital-based outpatient settings. It preserves respiration but elicits deviations in blood pressure and heart rate that have not required pharmacologic intervention. Dexmedetomidine offers a safe, effective, and efficient agent for sedation for children undergoing MRI in an outpatient setting.
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