Structured sedation programme for magnetic resonance imaging examination in children

Abstract

SummaryOne thousand, eight hundred and fifty-seven patients underwent magnetic resonance imaging following the establishment of a structured sedation programme. Forty-eight of these patients came from the intensive care unit with a secure airway and were therefore excluded from any further analysis. Oral sedation was to be given to children aged 5 years and below. For children Ն 6 years old, oral sedation could be given only if their level of co-operation was judged to be inadequate by the referring physician. Oral sedation consisted of chloral hydrate 90 mg.kg ¹1 (maximum 2.0 g) orally with or without rectal paraldehyde 0.3 ml.kg ¹1 . All magnetic resonance imaging requests for children who failed oral sedation as well as those referred for general anaesthesia from the outset were reviewed by a consultant anaesthetist who then allocated patients to undergo the procedure with either general anaesthesia or intravenous sedation. Scans requiring intravenous sedation or general anaesthesia were performed in the presence of a consultant anaesthetist. Intravenous sedation consisted of either a propofol 0.5 mg.kg ¹1 bolus followed by an infusion (maximum 3 mg.kg ¹1 .h ¹1 ) or midazolam 0.2-0.5 mg.kg ¹1 boluses. General anaesthesia was given using spontaneous ventilation with a mixture of 66% nitrous oxide in oxygen and isoflurane following either inhalation (sevoflurane) or intravenous (propofol) induction. One thousand and thirty-nine (57.4%) of the scans were done without sedation whereas 93 scans were performed during the consultant anaesthetist supervised sessions. Oral sedation failed in 50 out of 727 patients (6.9%). Eighty-seven per cent of children aged 5 years and below needed sedation compared with 4.5% of those aged over 10 years. Two patients who had only received chloral hydrate developed significant respiratory depression. This structured sedation programme has provided a safe, effective and efficient use of limited resources.

Application of magnetic resonance urography in diagnosis of congenital urogenital anomalies in children

“…Another drawback for MRU studies in pediatric patients would be the need for sedation or anesthesia especially in children of below the age of 5 years, those with mental retardation, or older patients who are anxious due to the unfamiliar environment [25]. For MRU in particular, motion artifacts should be at a minimum.…”

Feasibility of MR urography in neonates and infants with anomalies of the upper urinary tract

“…Our experience shows that oral chloralhydrate sufficiently sedates neonates and infants for up to 1 h. Together with immobilisation techniques, this approach guarantees a sufficient time slot for high-quality investigations in patients younger than 1 year, and allows a practical and efficient use of the MR unit. Older infants still need intravenous sedation; this is not discussed herein, as numerous reports and established sedation protocols exist [25,26,27,28]; however, since for scintigraphy sedation may also be required in some infants, sedation for MRU, particularly for functional assessment, appears less problematic: invasiveness is not increased; overall radiation burden is reduced; and additional anatomical information as well as visualisation of even non-functioning systems can be gained.…”

Pitfalls in magnetic resonance imaging

“…aufgrund der hier gewonnenen Ergebnisse eine weitergehende Diagnostik angefordert) und nach Aufklärung über das geplante anästhesiolo-gische Vorgehen eine schriftliche Einwilligung eingeholt. Vor der MRT-Untersuchung sind die entsprechenden Nahrungskarenzzeiten (2 h für klare Flüssigkeiten, 4 h für Muttermilch, 6 h für feste Nahrung einzuhalten; [35] [24,25,26,27,28,29,30].…”