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Propofol-remifentanil or sevoflurane for children undergoing magnetic resonance imaging? A randomised study
N A Pedersen1, A G Jensen, L Kilmose
1Department of Anaesthesiology, University of Copenhagen, Glostrup Hospital, Glostrup, Denmark. niels.anker.pedersen@regionh.dk
Insights
Propofol-remifentanil anesthesia for pediatric MRI reduced recovery time and delirium but required additional sedation during scans. Sevoflurane provided reliable imaging but increased emergence delirium in children.
Area of Science:
- Pediatric Anesthesiology
- Neuroimaging
Background:
- Pediatric MRI often requires anesthesia, with no universally ideal method.
- General anesthesia (GA) and sedation are common but have drawbacks.
Purpose of the Study:
- To evaluate propofol-remifentanil infusion as an alternative for maintaining anesthesia during pediatric MRI.
- To compare its efficacy and safety against sevoflurane.
Main Methods:
- 120 children (1-10 years, ASA 1-2) received anesthesia via propofol-remifentanil infusion (Group PR) or sevoflurane (Group S).
- Paediatric Anaesthesia Emergence Delirium (PAED) score, movement during MRI, and recovery room stay were assessed.
Main Results:
- Group PR showed significantly lower PAED scores and shorter recovery times compared to Group S.
- However, 15 children in Group PR required additional sedation during MRI due to movement, versus none in Group S.
Conclusions:
- Propofol-remifentanil infusion offers benefits in reduced emergence delirium and faster recovery post-pediatric MRI.
- Sevoflurane ensures scan reliability but is associated with higher emergence delirium rates.
Background:
Magnetic resonance imaging (MRI) of children is generally performed under sedation or with general anaesthesia (GA), but the ideal regimen has not been found. The aim of this study was to see if propofol-remifentanil would be a suitable alternative for the maintenance of anaesthesia in this category of patients.
Patients And Methods:
Children aged 1-10 years, American Society of Anesthesiologists physical status 1-2 were included. After induction with thiopental or sevoflurane, the children were randomised to maintenance of anaesthesia with an infusion of propofol and remifentanil (group PR) (56 μg/kg/min of propofol and 0.06 μg/kg/min of remifentanil) or with sevoflurane 1.3 MAC (group S). A binasal catheter was placed in group PR and a laryngeal mask airway in group S. The children breathed spontaneously. The Paediatric Anaesthesia Emergence Delirium (PAED) score (primary end point), the number of movements during MRI, and the length of stay in the recovery room (secondary endpoints) were recorded.
Results:
Sixty children were included in each group. A lower level of emergence delirium (measured as a lower PAED score) was found in group PR compared with group S, and the children in group PR were discharged earlier from the recovery room than the children in group S. However, 15 children in group PR vs. 0 in group S moved during the scan (P < 0.001).
Conclusion:
The PR infusion ensured a satisfactory stay in the recovery room, but additional boluses were necessary during the MRI. Sevoflurane was reliable during the MRI, but emergence delirium was a concern.
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