Anesthesia for pediatric magnetic resonance imaging: a review of practices and current pathways

Abstract

Purpose of review Magnetic resonance imaging (MRI) is an ever-expanding investigation modality in children. This review aims to present current strategies to perform MRI in pediatrics efficiently and safely. The latest evidence on approaches, safety and costs of MRI with no sedation or with sedation provided by anesthesiologists and non-anesthesiologists are outlined and discussed. Recent findings MRI under sedation provided by either anesthesiologists or non-anesthesiologists has a low incidence of minor adverse events and rarely severe complications. Propofol infusion with or without dexmedetomidine appears the ideal anesthetic, as it allows spontaneous breathing and fast turnover. Intranasal dexmedetomidine is safe and the most effective medication when a nonintravenous route is employed. New scanning techniques and patient's preparation methods can increase the chances to successfully perform MRI with no sedation by shortening sequences, reducing artifacts, and improving child's cooperation. Summary MRI under sedation can be considered safe. Proper patient selection, clear decision-making and medico-legal pathways are particularly necessary for nurse-only sedated scans. Nonsedated MRIs are feasible and cost-effective but require optimal scanning techniques and patient's preparation to be successful. Further research should be focused on identifying the most effective modalities to perform MRI without sedation and clarify protocols for the nurse-only sedations. Anesthesia service will likely remain pivotal for complex and critically ill patients and to provide assistance in case of adverse events.

Dexmedetomidine dosing for procedural sedation in children and adults: We can do better

“…However, these doses were associated with a high failure rate, as only 63% of patients were able to complete the magnetic resonance imaging without the need for propofol. These results are not surprising, as similar doses had already been shown to be insufficient in previous reports, which suggested the need to increase dexmedetomidine dose 6 . Mason and colleagues 7 reported a clinical experience in 747 children who received dexmedetomidine for sedation in MRI.…”