Anaesthesia with midazolam and S‐(+)‐ketamine in spontaneously breathing paediatric patients during magnetic resonance imaging

Abstract

We evaluated safety and efficacy of a sedation technique based on rectal and intravenous S-(+)-ketamine and midazolam to achieve immobilization during Magnetic Resonance Imaging (MRI). Thirty-four paediatric patients were randomly assigned to undergo either the sedation protocol (study group) or general anaesthesia (control group). Imaging was successfully completed in all children. Children in the study group received a rectal bolus (0.5 mg x kg(-1) midazolam and 5 mg x kg(-1) S-(+)-ketamine) and required additional i.v. supplementation (20+/-10 microg x kg(-1) x min(-1) S-(+)-ketamine and 4+/-2 microg x kg(-1) x min(-1) midazolam), spontaneous ventilation was maintained. Transient desaturation occurred once during sedation and four times in the control group (P=0.34). PECO2 was 5.3+/-0.5 kPa (40+/-4 mm Hg) in the study group and 4.1+/-0.6 kPa (31+/-5 mm Hg) in the control group (P<0.001). Induction and discharge times were shorter in the study group (P<0.001), recovery times did not differ significantly between the groups. Our study confirms that a combination of rectal and supplemental intravenous S-(+)-ketamine plus midazolam is a safe and useful alternative to general anaesthesia for MRI in selected paediatric patients.

Efficasy of different anesthetics for achieving deep sedation during magnetic resonance imaging in children: Anesthetics for a deep sedation during magnetic resonance imaging

“…Nažalost, ni jedan anestetik dat pojedinačno nema te kvalitete i jedino kombinacijom različitih anestetika mogu se postići željeni ciljevi 3 . Midazolam samostalno nije pogodan za MR sedaciju, jer je kratkodelujući anestetik i bolje ga je koristi u kombinaciji sa propofolom, fentanilom ili ketaminom 4 . Propofol je ultra-kratkodelujući sedativ-hipnotik, sa brzom indukcijom, pri čemu se sedacija mora održavati kontinuiranom infuzijom ili ponavljanim bolusima propofola.…”

O efeito da "sedação multifásica" no exame de tomografia computadorizada e ressonância magnética em crianças, pais e anestesiologistas

“…Recently, an alternative technique describing the use of rectally administered midazolam and S-(+)-ketamine was described. This technique was superior for a standard technique of general anesthesia with endotracheal intubation 3 . Sedative premedication with benzodiazepines is clearly effective in reducing anxiety and the amnesic effects may also help to reduce future distress with anesthesia.…”

“…Children frequently require sedation in order to be cooperative and immobile for imaging modalities in radiology units, namely the magnetic resonance imaging (MRI) and computerized tomography (CT) procedures [1][2][3][4][5][6] . Moreover, imaging procedures that are not applied under adequate sedation necessitates repetition of the procedure, resulting in a significant loss of revenue to the institution, lost work time and, perhaps most importantly, delayed diagnosis.…”

Sedation and analgesia for brief diagnostic and therapeutic procedures in children

“…Ketamine/S-ketamine [7,12,16,17,19,29,37,38,46,48,55,58,59] Ketamine is one of the most frequently used analgesic agents in children, possibly because it provides concomitant stable respiratory and cardiovascular function. Ketamine acts as an antagonist at the N-methyl-D-aspartat (NMDA)-receptor, and stimulates via a re-uptake inhibition of catecholamine's up-regulation of the sympathetic efferent pathway, resulting in an increase of heart rate and blood pressure.…”