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FMRI under sedation: what is the best choice in children?
Byron Bernal1, Sandra Grossman, Rafael Gonzalez
1Department of Radiology, Miami Children's Hospital, USA.
Insights
Comparing sedation methods for pediatric fMRI in epilepsy surgery, this study found no significant difference in brain activation. Pentobarbital and propofol showed fewer failures but pentobarbital had more side effects.
Area of Science:
- Pediatric neuroimaging
- Anesthesiology
- Epilepsy surgery
Background:
- Pediatric functional magnetic resonance imaging (fMRI) often necessitates sedation.
- Evaluating sedation efficacy is crucial for successful pediatric neuroimaging in epilepsy surgery evaluations.
Purpose of the Study:
- To compare different sedation regimens for pediatric fMRI.
- To determine which medication yields the fewest procedural failures and optimal brain activation.
Main Methods:
- 100 children undergoing fMRI for epilepsy surgery workup were divided into groups receiving Pentobarbital, Propofol, Dexmedetomidine, or Sevoflurane.
- Outcomes assessed included failure rates, activation rank, adverse effects, anesthesia, and recovery times.
- BOLD sequences and block-design paradigms (auditory, visual) were used, with activation ranked into five categories. Statistical analysis included ANOVA.
Main Results:
- Pentobarbital showed the fewest failures for the auditory task, followed by Propofol. Sevoflurane had the highest failure rate for both tasks.
- For the visual task, Propofol after Dexmedetomidine yielded the fewest failures.
- No statistically significant differences in brain activation were observed between groups for either task (auditory: P = 0.42; visual: P = 0.077).
- Sevoflurane offered the shortest recovery time, followed by Propofol. Pentobarbital was associated with agitation and cardiac complications in 28% of cases.
Conclusions:
- Different sedative medications did not produce statistically significant differences in brain activation during pediatric fMRI for intractable epilepsy.
- A trend towards fewer failures was noted with Pentobarbital and Propofol.
- Pentobarbital was linked to a higher incidence of adverse effects, despite a trend toward fewer failures.
Background:
Pediatric fMRI may require sedation. The aim of this study is to compare different sedation schemes to determine which medication yields least failures and the best activation.
Methods:
A total of 100 children who had fMRI performed as part of the work up for epilepsy surgery, were divided into different medication groups (Pentobarbital, Propofol, Dexmedetomidine, Sevoflurane). Comparison was performed among the groups for number of failures, rank of activation, adverse effects, anesthesia time, and recovery time. The study was approved by the IRB and followed all HIPAA guidelines. BOLD sequences were utilized to perform two block-design paradigms (auditory and visual). The activation was ranked into 5 categories according to the presence and localization of the activation. Descriptive and parametric statistics (ANOVA) were utilized to look for significant differences.
Results:
Pentobarbital yielded the least amount of failures, for the auditory task, followed by propofol, while sevoflurane yielded the highest number of failures for both tasks. In the visual task, propofol administered after dexmedetomidine resulted in the least number of failures. Brain activations were not statistical different (auditory: ANOVA, P = 0.42; F = 1.01; visual: ANOVA, P = 0.077; F = 2.1). The shortest recovery time was obtained with sevoflurane, followed by propofol. Agitation and cardiac complications were seen in 28% of cases in the pentobarbital group.
Conclusion:
No statistically significant difference in brain activation was found utilizing different sedative medications in children with intractable epilepsy. A trend toward less failures was obtained with pentobarbital and propofol; however pentobarbital was more frequently associated with undesirable side effects.
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