Is propofol infusion better than inhalational anaesthesia for paediatric MRI?

Abstract

graduate doctors the opportunity to experience the same subjective sensation that they inflict on their patients as a basis for changing their practice. We believe that from this small project we are even more convinced of the need to teach this technique to undergraduates and graduates, however experienced, in order to make cannulation a pain free technique.

Propofol total intravenous anesthesia for MRI in children

“…We documented six episodes of movement during scanning with a higher risk of movement when a lower infusion rate of 150 lgAEkg )1 AEmin )1 was used. A number of previous reports have described propofol techniques using infusion rates lower than described in our study (5,(7)(8)(9)(10)(11)(12), with one group receiving premedication with midazolam (8). Four of these papers assessed episodes of patient movements.…”

“…In a study of 30 children receiving inhalational induction and propofol TIVA Frankville et al reported that a propofol rate of 100 μ g·kg −1 ·min −1 prevented movement (10). MacIntyre and Sury however reported movement as a major drawback using similar low infusion rates (12). In a study of 82 children, Levati et al reported a relationship between smaller children (under 10 kg) and a higher per kilogram induction (mean 5.4 mg·kg −1 ) and maintenance (mean 166 μ g·kg −1 ·min −1 ) requirement of propofol to prevent movement (11).…”

Procedural sedation analgesia

“…[ 14 ] Appreciable airway effects occur in 1-2% but these should only need simple support measures. Occasionally, propofol alone does not suppress involuntary movements,[ 45 ] but a recent report confirms that propofol does not trigger epileptiform cortical electric activity in epileptic children. [ 46 ]…”

Deep sedation and minimal anesthesia

“…Appreciable airway effects occur in 1–2% but these should only need simple support measures. Occasionally, propofol alone does not suppress involuntary movements (42), but a recent report confirms that propofol does not trigger epileptiform cortical electric activity in epileptic children (43). Sevoflurane and other vapors can be given so that, after induction, the children can be positioned so that airway support is unnecessary (16,44,45).…”