The frequency of emergence delirium in children undergoing outpatient anaesthesia for magnetic resonance imaging

Abstract

Aim:The aim of this study was to investigate the effect on the occurrence of emergence delirium of propofol and ketofol with intranasal dexmedetomidine and midazolam applied as premedication to paediatric patients during magnetic resonance imaging (MRI). Methods:The study included children aged 2-10 years who received sedation for MRI, separated into four groups. Group MP (midazolam-propofol) received intranasal midazolam (0.2 mg/kg) for premedication and intravenous (IV) propofol (1 mg/ kg) as the anaesthetic agent. Group MK (midazolam-ketofol) received intranasal midazolam (0.2 mg/kg) for premedication and IV ketofol (1 mg/kg) as the anaesthetic agent. Group DP (dexmedetomidine-propofol) received intranasal dexmedetomidine (1 mcg/kg) for premedication and IV propofol (1 mg/kg) as the anaesthetic agent.Group DK (dexmedetomidine-ketofol) received intranasal dexmedetomidine (1 mcg/kg) for premedication and IV ketofol (1 mg/kg) as the anaesthetic agent. The Paediatric Anaesthesia Emergence Delirium (PAED) scale was used to evaluate delirium. A PAED score ≥ 10 was accepted as delirium.Results: Statistical analysis was made of 140 paediatric patients. Delirium developed in 1.42% of all the patients, and in 5.7% of Group MP. The mean Aldrete and PAED scores were lower and the length of stay in the recovery room was shorter in Group DP than in the other groups. The need for additional anaesthetic was highest in Group DP at 94.3% and lowest in Group DK at 14.3%. The groups administered ketofol were observed to have a lower requirement for additional anaesthetic. Conclusion:Delirium was seen at a very low rate only in the Group MP and it is difficult to say the best combination in terms of delirium frequency. However, intranasal dexmedetomidine and IV ketofol seem to be better and safer than the other groups in terms of the need for additional doses and the number of side effects. The addition of ketamine to propofol reduces the need for additional doses with a synergistic effect.

Combined use of intranasal Dexmedetomidine and an oral novel formulation of Midazolam for sedation of young children during brain MRI examination: a prospective, single-center, randomized controlled trial

“…To overcome this difficulty, it is often necessary to perform clinical sedation or general anesthesia to ensure a successful examination of MRI. Due to the cost of general anesthesia, MRI examination assisted by sedation is a simple and effective method and has become a new direction of research in this field [ 1 , 2 ].…”

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

“…Other sedation protocols have been also investigated. Midazolam-propofol, midazolam-ketofol, dexmedetomidine-ketofol regimens showed similar efficacy and safety profile to a dexmedetomidine-propofol technique [23]. A metanalysis [33 ▪ ] showed that intravenous infusion of dexmedetomidine does not increase the incidence of hypotension, reduces the risk of desaturation (relative risk (RR) = 0.42, 95% confidence interval (CI) 0.20 to 0.86), but delays the onset (8.13 min, 95% CI 4.64 to 11.63) and recovery time (5.22 min, 95% CI 0.35 to 10.09).…”

“…Thus, in case of complications (e.g., airway obstruction, cardiac arrest), the availability of emergency equipment, which is often not MRI compatible (e.g., videolaryngoscope, defibrillator), and personnel support are limited [21 ▪ ,22]. Second, approximately 1.4–5.7% of the children undergoing sedated MRI experience emergence delirium on awaking [23], a clinical phenomenon that puts the child at risk of self-injury and maladaptive behavioral changes that can persist for weeks [24]. Third, in case of MRI under sedation or general anesthesia, fasting is recommended [22,25], which increases child's discomfort and risk of hypotension [24].…”

Evaluation of Demographic and Clinical Characteristics of Celiac Patients: A Single Center Experience

“…However, avoiding gluten intake is extremely difficult due to hidden gluten from food contamination. Besides, the CD individuals benefit from a supplementary diet with vita Hydrolysis of toxic gliadin peptides are being studied (5)(6)(7).…”

“…The prevalence of CD varies significantly across and within different countries (5)(6)(7). The prevalence rate in Turkey ranges between 0.5% and 1.3% (8) Although there has been a substantial increase in CD diagnoses over the last 30 years, many patients remain undiagnosed.…”