The Effects of Dexmedetomidine on Children Undergoing Magnetic Resonance Imaging: A Systematic Review and Meta-Analysis

Abstract

Background: Magnetic Resonance Imaging (MRI) is a valuable diagnostic tool but often requires sedation to complete, especially in children. Dexmedetomidine (DEX) is an a2 agonist, for which there are experimental findings that support its potential neuroprotective effects. Given the potential risks of anesthetic drugs, we ran this study to examine DEX’s effectiveness and cardiopulmonary safety as a sedative drug for children undergoing MRI. Material and Methods: Systematic research was conducted in PubMed, Google Scholar, Scopus and Cochrane databases for randomized controlled trials published between 2010 and 6th/2022 and involving children undergoing MRI who received DEX as sedative medication. The records which met the including criteria, after indexing via the PRISMA chart and assessing for bias, were processed, and a meta-analysis was carried out with the random effects method. Results: Thirteen studies were included. Out of 6204 measurements obtained, in 4626, it was planned for the participants to only receive DEX (measure group) as an anesthetic drug throughout the procedure. The participants’ mean age was 57 months (Ι2 = 4%, τ2 = 0.5317, p = 0.40). A total of 5.6% (95% CI: 0.6–14.1%, I2 = 98%, p < 0.01) of the patients needed a second dose of DEX. In total, 6% (95% CI: 1–15%, I2 = 93%, τ2 = 0.0454, p < 0.01) required the administration of another drug, besides DEX, to complete the imaging (sedation failure). The effectiveness of the only-DEX method was 99% (95% CI: 97.5–100%, I2 = 81%, τ2 = 0.0107, p < 0.01). The whole rate of adverse events was 15% (95% CI: 9.3–21.5%, I2 = 92%, p < 0.01). Hypotension was reported in 8.7% of the cases (95% CI: 3.1–16.4%, I2 = 84%, p < 0.01), hypertension in 1.1% (95% CI: 0–5.4%, I2 = 89%, p < 0.01), bradycardia in 10% (95% CI: 4–18%, I2 = 95%, p < 0.01) and desaturation in 1.2% (95% CI: 0–4%, I2 = 68%, p < 0.01). There was no statistically significant incidence in respiratory rate decrease (comparing the children who received DEX to their baseline). Five cases of vomiting and one of apnea were recorded. Conclusions: Given that DEX seems to be an effective as well as respiratory and hemodynamically safe drug, it may be a future spotlight in (pediatric) sedation for imaging procedures such as MRI.