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Trends in Pediatric MRI sedation/anesthesia at a tertiary medical center over time
Amy E Vinson1, James Peyton1, Anna Kordun1
1Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital & Harvard Medical School, Boston, MA.
Insights
Pediatric MRI sedation trends show a shift from propofol-only to propofol-dexmedetomidine combinations, with overall adverse events remaining low. This study highlights adaptable anesthetic practices and patient safety in pediatric imaging.
Area of Science:
- Pediatric Anesthesiology
- Medical Imaging Safety
- Pharmacological Trends
Background:
- Hundreds of thousands of children annually require sedation or anesthesia for MRI scans.
- Current anesthetic techniques for pediatric MRI vary significantly, with unknown safety implications.
Purpose of the Study:
- To analyze trends in anesthetic practices for pediatric MRI sedation/anesthesia over seven years.
- To determine the rates of adverse events associated with different anesthetic techniques, patient age, and ASA physical classification status (ASA-PS).
Main Methods:
- Analysis of 24,052 anesthetics for pediatric MRI scans (May 2013 - Dec 2019).
- Focus on medication trends, adverse events (hypoxia, hypotension, bradycardia), and statistical analysis including Cochran-Armitage test and multivariable logistic regression.
- Adverse events defined by deviation from age-specific norms.
Main Results:
- A notable decrease in "propofol-only" techniques and an increase in propofol-dexmedetomidine combinations were observed.
- Mild desaturation occurred in 4.22% of cases; significant hypoxia was rare (0.44%).
- Bradycardia (2.39%) and hypotension (1.75%) were infrequent, with major adverse events being rare.
Conclusions:
- This study represents the largest report on anesthesiologist-administered MRI sedation/anesthesia in a major children's hospital.
- Anesthetic techniques are dynamic and show significant shifts over time within a large healthcare system.
- The findings support a high safety profile for pediatric MRI sedation, even with a high-risk patient cohort.
Background:
Each year, hundreds of thousands of children require sedation/anesthesia to facilitate MRI scans. Anesthetic techniques for accomplishing sedation/anesthesia vary widely between institutions and providers, with unclear implications for patient safety.
Aims:
We sought to establish trends in anesthetic practice for pediatric MRI sedation/anesthesia across a 7-year period and determine rates of adverse events, considering technique used, age, and ASA physical classification status (ASA-PS).
Methods:
Using established data resources, we analyzed 24 052 anesthetics performed by anesthesiologists for MRI scans between 5/1/2013 and 12/31/2019 on patients less than 18 years old, focusing on medications used, trends of use, and associated adverse events. Adverse events (hypoxia, hypotension, bradycardia) were defined by deviation from age norms and accessed via the electronic anesthetic record database. The Cochran-Armitage test was used to assess trends over time in categorical data, and one-way ANOVA was used to analyze continuous data. Multivariable logistic regression analysis was implemented to determine the independent associations between anesthetic technique and adverse events while adjusting for age, ASA-PS, and weight.
Results:
The most significant trends noted were a decrease in "propofol-only" anesthetic techniques and an increase in propofol and dexmedetomidine combination techniques. Mild desaturation (80-89% SpO2 ) occurred in 4.22% of cases with more significant hypoxia much rarer (0.44% of cases having desaturation <70% SpO2 ). Bradycardia occurred in 2.39% of cases and hypotension in 1.75% of cases. Major adverse events were rare.
Conclusions:
We provide the largest report of the nature of MRI sedation/anesthesia as practiced by anesthesiologists in a large children's hospital. We demonstrate that, even in a large system, anesthetic techniques are pliable and shift significantly over time. Our data also support a high level of safety within our system, despite a case mix likely higher in risk than those in most of the previously published studies.
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