Pediatric Sedation/Anesthesia for<scp>MRI</scp>: Results From the Pediatric Sedation Research Consortium

Mallory, Michael D.; Travers, Curtis; Cravero, Joseph P.; Kamat, Pradip; Tsze, Daniel S; Hertzog, James H.

doi:10.1002/jmri.28392

Cited by 18 publications

(14 citation statements)

References 16 publications

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“…Effective management and control of intraoperative and postoperative pain are essential in perioperative hip disease to minimize opioid use and its side effects. In our facility, most pediatric hip surgeries are performed under spinal anesthesia and propofol sedation (12), with preserved spontaneous ventilation. However, the 4-year-old boy had general anesthesia due to the myelomeningocele (13,14).…”

Section: Discussionmentioning

confidence: 99%

Pericapsular Nerves Group (PENG) Block in Children under Five Years of Age for Analgesia in Surgery for Hip Dysplasia: Case Report

Domagalska¹,

Wieczorowska‐Tobis²,

Reysner³

et al. 2023

Preprint

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Introduction The Pericapsular Nerve Group (PENG) block is a novel technique that allows for analgesia of the anterior hip capsule via the articular branches of the accessory obturator nerve and femoral nerve, which have a significant role in the innervation of the hip capsule. PENG blockade is effective in both adult and pediatric patients. However, there are no studies in the available literature on patients under five years of age. Herein, we describe our experience with two pediatric patients with hip dysplasia. Purpose This study aimed to evaluate the analgesic effect of the pericapsular nerves group (PENG) in small children undergoing hip surgery. Patients and methods This study included two patients, aged 2 and 4 years old, who qualified for hip surgery. General or spinal anesthesia with the addition of a PENG block was performed. During the procedure, the basic hemodynamic parameters were monitored. After the surgery, the patients received 15mg/kg-1 iv paracetamol every 6 hours to prevent rebound pain. The pain was assessed using the FALCC score. The 15mg/kg-1 metamizole was administered if the FLACC score was 3. In the FLACC score 4, the application of 0,2mg/kg-1 Nalpain was ordered. Results The patient's hemodynamic parameters were stable and within normal range. FLACC scores from all patients ranged from 0 and 3 in the first 24 h period. One patient required metamizole 12 hours after surgery. No evidence of block complications was observed. Conclusions This case series showed that PENG block provided adequate postoperative analgesia and assured opioid-free pain management. However, we are convinced that future randomized, controlled trials are needed in this field.

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Section: Discussionmentioning

confidence: 99%

Pericapsular Nerves Group (PENG) Block in Children under Five Years of Age for Analgesia in Surgery for Hip Dysplasia: Case Report

Domagalska¹,

Wieczorowska‐Tobis²,

Reysner³

et al. 2023

Preprint

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“…Propofol has been the mainstream medication used by anesthesiologists for sedated MRIs. Propofol, alone or in combination with other medications, appears to be commonly administered also by non-anesthesiologist physicians [10,29]. Advantages are fast induction, good hemodynamic stability and fast recovery allowing patient discharge within 45 min in 99% of cases [30].…”

Section: Anesthesiologist and Non-anesthesiologist Physician Assisted...mentioning

confidence: 99%

“…A retrospective analysis from the Pediatric Sedation Research Consortium showed that anesthesiologist-provided exams accounted for only 9.8% of almost 110,000 sedated MRIs performed in the United States from 2011 to 2017 [10]. Intensivists and emergency physicians were involved more often (49.3% and 29.2%, respectively).…”

Section: Anesthesiologist and Non-anesthesiologist Physician Assisted...mentioning

confidence: 99%

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

Fonseca

Garbin

Bertolizio

2023

Current Opinion in Anaesthesiology

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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.

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“…Serious adverse events such as pulmonary aspiration of gastric content, cardiac arrest, unplanned admission to ICU and death are rare, whereas minor events such as airway obstructions and desaturations are more common with an incidence ranging from 0.9 to 2.3% and from 0.7 to 3.9%, respectively [5,8 ▪▪ ,9,10]. Other common complications during procedural sedation are related to intravenous access, inadequate sedation, agitation and vomiting [5,8 ▪▪ ]. Adverse events are not only a cause for morbidity and mortality but can also disrupt processes and thus lead to reduced procedural quality.…”

Section: Adverse Events In Paediatric Procedural Sedationmentioning

confidence: 99%

Safety and quality in paediatric procedural sedation: what really matters?

Röher

Becke‐Jakob

Eich

2023

Current Opinion in Anaesthesiology

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Purpose of reviewThis review gives an overview of the safety aspects for paediatric procedural sedation and a discussion of possibilities for optimizing structure, processes and outcomes.Recent findingsProcedural sedation in paediatric patients is performed by providers of different specialties and compliance with safety standards is a basic requirement regardless of provider specialty. This includes preprocedural evaluation, monitoring, equipment and profound expertise of sedation teams. The choice of sedative medications and the possibility of incorporating nonpharmacological methods play an important role for optimal outcome. In addition, an ideal outcome from the patient's perspective includes optimized processes and clear and empathetic communication.SummaryInstitutions providing paediatric procedural sedation must ensure the comprehensive training of sedations teams. Furthermore, institutional standards for equipment, processes and optimal choice of medication depending on performed procedure and comorbidities of the patient must be established. At the same time, organizational and communication aspects should be considered.

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Pediatric Sedation/Anesthesia forMRI: Results From the Pediatric Sedation Research Consortium

Cited by 18 publications

References 16 publications

Pericapsular Nerves Group (PENG) Block in Children under Five Years of Age for Analgesia in Surgery for Hip Dysplasia: Case Report

Pericapsular Nerves Group (PENG) Block in Children under Five Years of Age for Analgesia in Surgery for Hip Dysplasia: Case Report

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

Safety and quality in paediatric procedural sedation: what really matters?

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