A retrospective comparison of propofol to dexmedetomidine for pediatric magnetic resonance imaging sedation in patients with mucopolysaccharidosis type II

Abstract

Summary Background Mucopolysaccharidosis type II patients are reported to have an elevated incidence of difficult airway. Propofol is a commonly used sedative for magnetic resonance imaging in pediatric patients, but patients who receive it may exhibit dose‐dependent upper airway obstruction and respiratory depression. Dexmedetomidine also provides adequate procedural sedation with a relatively low risk of airway obstruction. Accordingly, we introduced the use of dexmedetomidine in our practice to reduce the risk of airway obstruction during magnetic resonance imaging procedures. Aims The aim of this study was to evaluate the incidence of artificial airway interventions in patients sedated with propofol and compare it to that in patients sedated with dexmedetomidine in patients with mucopolysaccharidosis type II during magnetic resonance imaging procedures. Methods All mucopolysaccharidosis type II patients undergoing magnetic resonance imaging at our institution between April 2014 and February 2018 were included in this study. The patients were divided into two groups according to whether they were managed before and after the introduction of dexmedetomidine: those who were sedated with propofol (group P) and those who were sedated with dexmedetomidine (group D). Results Forty‐six sedations were performed in 27 patients. Artificial airway interventions were significantly more frequent during propofol‐based than dexmedetomidine‐based sedation: 14 of 32 (43.8%) in group P and 1 of 14 (7.1%) in group D (odds ratio, 10.11; 95% confidence interval, 1.18‐86.85; P = 0.018). Time to awake and time to discharge were similar between groups. Changes in hemodynamic variables also did not significantly differ between groups. Conclusion Dexmedetomidine provides an adequate level of sedation and is associated with lower rates of artificial airway interventions compared to propofol. Therefore, dexmedetomidine may offer advantages for preserving the native airway compared to propofol when administered during magnetic resonance imaging scans in patients with mucopolysaccharidosis type II.

Prospective, randomised comparison of two intravenous sedation methods for magnetic resonance imaging in children

“…Children with sleep apnoea undergoing MRI required fewer airway support interventions when dexmedetomi dine at a 2 µg kg -1 IV loading dose followed by an infusion of 2 µg kg -1 h -1 was used for sedation, in comparison to propofol [19]. Similar results -more airway problems after propofol -were reported by Kang et al [20]. In our study there was no significant difference between the respiratory events between dexmedetomidine and propofol groups, maybe due to the low dose of the drugs, especially propofol.…”

Effectiveness of single loading dose of dexmedetomidine combined with propofol for deep sedation of endoscopic retrograde cholangiopancreatography (ERCP) in elderly patients: a prospective randomized study

“…Unlike our and other research results [ 9 , 26 ], in a previous study, Muller et al showed a more significant reduction in blood pressure in patients undergoing ERCP and concluded dexmedetomidine was associated with greater hemodynamic instability [ 27 ]. Based on the biphasic effect of dexmedetomidine on blood pressure, dexmedetomidine was used only as a single loading dose to counteract the decreased blood pressure produced by propofol during anesthesia induction in our study [ 11 , 28 ]. To overcome hypotension, a frequent side effect of dexmedetomidine, we did not infuse the dexmedetomidine continuously at a low rate during ERCP.…”

The Effects of Dexmedetomidine on Children Undergoing Magnetic Resonance Imaging: A Systematic Review and Meta-Analysis

“…Magnetic Resonance Imaging (MRI) is very important for early, targeted, effective and valid diagnoses and therefore the early initiation of the treatment of many diseases; however, the administration of sedative drugs, with propofol, chloral hydrate, midazolam and ketamine being amongst the most common sedative drugs used [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 ], is often required for MRI to be completed, especially in the pediatric population. Nevertheless, currently available anesthetic drugs’ possible side effects, such as respiratory and/or cardiovascular depression, addiction, psychotic disorders, mutagenic effects and reductions in neurons in the limbic system, with the latter possibly leading to permanent neurological disorders, pose several limitations regarding their use [ 10 , 11 , 12 , 13 , 14 , 15 , 16 ] and require the careful evaluation of their safety profile to select the appropriate method to monitor patients during and after the sedation procedure. Therefore, the need for research into new drugs with better safety profiles has arisen.…”