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Pediatric Sedation/Anesthesia for MRI: Results From the Pediatric Sedation Research Consortium
Michael D Mallory1,2, Curtis Travers2, Joseph P Cravero3
1Pediatric Emergency Medicine Associates, Children's Healthcare of Atlanta at Scottish Rite, Atlanta, Georgia, USA.
Background:
Magnetic resonance imaging (MRI) is the most common imaging procedure requiring sedation/anesthesia in children. Understanding adverse events associated with sedation/anesthesia is important in making decisions regarding MRI vs. other imaging modalities. No large studies have evaluated the practice of pediatric sedation/anesthesia for MRI by a variety of pediatric specialists.
Purpose:
Utilize a large pediatric sedation database to characterize the patients and adverse events associated with sedation/anesthesia for pediatric MRI.
Study Type:
Retrospective analysis of prospectively collected data.
Subjects:
The Pediatric Sedation Research Consortium (PSRC) has 109,947 entries for sedations for MRI from November 10, 2011 through December 18, 2017.
Assessment:
Patient demographics, sedative medications, interventions, and adverse events are described. Associations with adverse events were assessed. Trends in sedative medications used over time are examined.
Statistical Tests:
Descriptive statistics, Chi-Squared and Fisher's Exact tests for categorical variables, logistic regression and assessment of trend using logistic regression and other method.
Results:
A total of 109,947 MRI-related sedations were examined. Most subjects (66.2%) were 5 years old or younger. Seizure or other neurologic issue prompted MRI in 63.7% of cases. Providers responsible for sedation/anesthesia included intensivists (49.3%), emergency medicine physicians (28.2%), hospitalists (10.2%), and anesthesiologists (9.8%). The most commonly used sedative agent was propofol (89.1%). The most common airway intervention was supplemental oxygen (71.7%), followed by head/airway repositioning (20.6%). Airway-related adverse events occurred in 8.4% of patients. Serious adverse events occurred in only 0.06% of patients, including three cases of cardiac arrest. No mortality was recorded. There was a statistically significant increase in the use of dexmedetomidine over time.
Data Conclusions:
Overall, adverse event rates were low. Sedation/anesthesia with propofol infusion and natural airway was the most common method used by this varied group of sedation providers. The use of dexmedetomidine increased over time.
Evidence Level:
4 TECHNICAL EFFICACY: Stage 5.
Insights
Pediatric MRI sedation is generally safe, with low adverse event rates. Propofol remains the most common agent, but dexmedetomidine use is increasing among pediatric specialists.
Area of Science:
- Pediatric Anesthesiology
- Medical Imaging
- Patient Safety
Background:
- Magnetic resonance imaging (MRI) is a common pediatric imaging procedure requiring sedation/anesthesia.
- Understanding adverse events is crucial for comparing MRI with alternative imaging modalities.
- Large-scale studies on pediatric sedation for MRI by diverse specialists are lacking.
Purpose of the Study:
- To characterize patients and adverse events associated with pediatric sedation/anesthesia for MRI.
- To analyze trends in sedative medication use over time.
Main Methods:
- Retrospective analysis of prospectively collected data from the Pediatric Sedation Research Consortium (PSRC).
- Included 109,947 sedations for MRI between November 2011 and December 2017.
- Descriptive statistics and logistic regression were used to assess associations and trends.
Main Results:
- Most patients (66.2%) were 5 years or younger; 63.7% underwent MRI for neurological issues.
- Propofol was the most common sedative (89.1%); airway interventions included oxygen and repositioning.
- Airway-related adverse events occurred in 8.4%, serious adverse events in 0.06% (3 cardiac arrests), with no mortality.
- Dexmedetomidine use significantly increased over time.
Conclusions:
- Pediatric MRI sedation is associated with low adverse event rates.
- Propofol infusion with a natural airway is the most frequent sedation method.
- Dexmedetomidine use is trending upward among various pediatric sedation providers.
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