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Updated: Feb 3, 2026
Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
Incidence and risk factors of unplanned intubation during pediatric sedation for MRI
Doyeon Kim1, Eun Kyung Lee1, Ji Seon Jeong1
1Department of Anesthesiology and Pain medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Insights
Pediatric MRI sedation can lead to unexpected intubation in about 2% of cases. Key risk factors include American Society of Anesthesiologists (ASA) class III, premature birth, GERD, and congenital heart disease.
Area of Science:
- Pediatric Anesthesiology
- Radiology
- Medical Informatics
Background:
- Pediatric patients often require sedation for MRI scans due to immobility challenges.
- Sedation is a common practice to ensure successful MRI acquisition in children.
Purpose of the Study:
- To determine the incidence of unanticipated intubation during pediatric MRI sedation.
- To identify contributing factors and risk factors for unplanned intubation in this population.
Main Methods:
- A retrospective observational study reviewing 1165 pediatric patient charts undergoing sedation for MRI.
- Data collected included patient demographics, MRI region, medication, sedation duration, and adverse events.
- Univariate and multivariate logistic regression analyses were performed to identify risk factors.
Main Results:
- The incidence of unexpected intubation during MRI sedation was approximately 2%.
- Significant risk factors identified included American Society of Anesthesiologists (ASA) class III, premature birth, gastroesophageal reflux disease (GERD), and congenital heart disease.
Conclusions:
- Physicians should screen for identified risk factors before pediatric MRI sedation.
- Maintaining adequate sedation and monitoring are crucial to prevent unplanned intubations in pediatric MRI patients.
Background:
It is often difficult for the pediatric patient to cooperate or to remain immobile during MR scans. Therefore, sedation is usually needed for children.
Purpose:
To evaluate the incidence and contributing factors of unanticipated intubation during sedation for MRI scan in children.
Study Type:
Retrospective observational study.
Population/Subjects:
In all, 1165 charts were reviewed retrospectively of patients who had been sedated by anesthesiologists at a single institution from May 2015 to June 2016.
Assessment:
Patient's demographics, the region of the MRI scan, total amount of medication, duration of sedation, and any adverse event during MRI were assessed. The adverse events during sedation including airway obstruction, apnea, desaturation, bradycardia, and hypotension were also assessed.
Statistical Tests:
Risk factors of unplanned intubation during MRI sedation were identified by univariate and multivariate analysis. Firth's exact logistic regression was used for univariate and multivariate analysis. According to the results from multiple logistic regression, a nomogram was developed to predict the risk.
Results:
A total of 1165 children aged 7 days to 18 years with sedation used during an MRI scan during the study period showed an incidence of unexpected intubation as ~2% (n = 23, 95% confidence interval [CI]; 0.0123, 0.0295). Multivariate logistic regression revealed the following risk factors of unplanned intubation: American Society of Anesthesiologists (ASA) class III patients (odds ratio [OR] 1.212, P < 0.001), premature birth (OR 2.317, P < 0.001), and the presence of gastroesophageal reflux disease (GERD) (OR 1.474, P < 0.001) or congenital heart disease (OR 1.118, P < 0.001).
Data Conclusion:
This study identified risk factors of unplanned intubation as follows: ASA class III patients, premature birth, and the presence of GERD or congenital heart disease. The physician should screen risk factors of unexpected intubation and maintain adequate sedation during MRI scans in pediatric patients. Level of Evidence 3. Technical Efficacy Stage 5. J. Magn. Reson. Imaging 2019;49:1053-1061.
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