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Needle-free pharmacological sedation techniques in paediatric patients for imaging procedures: a systematic review

Ingeborg de Rover1, Jasper Wylleman2, Jaap J Dogger1

  • 1Department of Anaesthesiology, Sophia Children's Hospital, Rotterdam, the Netherlands.

British Journal of Anaesthesia
|October 25, 2022
PubMed

Insights

Needle-free sedation for pediatric MRI varies widely. Oral pentobarbital and inhaled sevoflurane show high success rates, while midazolam has lower efficacy in children aged 0-8 years.

Area of Science:

  • Pediatric Anesthesiology
  • Radiology
  • Pharmacology

Background:

  • Sedation is increasingly vital for pediatric imaging procedures.
  • This review focuses on needle-free pharmacological sedation for children aged 0-8 undergoing MRI.
  • Excludes invasive methods like IV/IM medication or advanced airway devices.

Approach:

  • Systematic literature search of Embase, MEDLINE, Web of Science, and Cochrane databases.
  • Meta-analysis of sedation success rates, onset, duration, recovery, and adverse events.
  • Included 67 studies with 22,380 pediatric participants.

Key Points:

  • Oral pentobarbital (99%) and inhaled sevoflurane (98%) demonstrated the highest sedation success rates.
  • Oral chloral hydrate (94%) and combined oral chloral hydrate/intranasal dexmedetomidine (95%) were also effective.
  • Rectal, oral, or intranasal midazolam (36%) and intranasal dexmedetomidine alone (62%) showed lower success rates.

Conclusions:

  • Significant variability exists in needle-free sedation techniques, medications, and dosages for pediatric MRI.
  • Success rates ranged broadly from 36% to 98% across different methods.
  • Informed selection of sedation strategies is crucial for optimizing pediatric MRI procedures.
Abstract

Keywords:
MRIbuccal administrationconscious sedationdeep sedationhypnoticsintranasal administrationoral administrationrectal administrationsedation

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