Trends in Pediatric MRI sedation/anesthesia at a tertiary medical center over time

Abstract

Background: Each year, hundreds of thousands of children require sedation/anesthesia to facilitate MRI scans. Anesthetic techniques for accomplishing sedation/anesthesia vary widely between institutions and providers, with unclear implications for patient safety. Aims:We sought to establish trends in anesthetic practice for pediatric MRI sedation/ anesthesia across a 7-year period and determine rates of adverse events, considering technique used, age, and ASA physical classification status (ASA-PS).Methods: Using established data resources, we analyzed 24 052 anesthetics performed by anesthesiologists for MRI scans between 5/1/2013 and 12/31/2019 on patients less than 18 years old, focusing on medications used, trends of use, and associated adverse events. Adverse events (hypoxia, hypotension, bradycardia) were defined by deviation from age norms and accessed via the electronic anesthetic record database. The Cochran-Armitage test was used to assess trends over time in categorical data, and one-way ANOVA was used to analyze continuous data. Multivariable logistic regression analysis was implemented to determine the independent associations between anesthetic technique and adverse events while adjusting for age, ASA-PS, and weight. Results:The most significant trends noted were a decrease in "propofol-only" anesthetic techniques and an increase in propofol and dexmedetomidine combination techniques. Mild desaturation (80-89% SpO 2 ) occurred in 4.22% of cases with more significant hypoxia much rarer (0.44% of cases having desaturation <70% SpO 2 ). Bradycardia occurred in 2.39% of cases and hypotension in 1.75% of cases. Major adverse events were rare. Conclusions:We provide the largest report of the nature of MRI sedation/anesthesia as practiced by anesthesiologists in a large children's hospital. We demonstrate that, even in a large system, anesthetic techniques are pliable and shift significantly over time. Our data also support a high level of safety within our system, despite a case mix likely higher in risk than those in most of the previously published studies.

Trends and patterns in the practice of pediatric sedation for magnetic resonance imaging in Japan: A longitudinal descriptive study from 2012 to 2019

“…This study investigated the trends and patterns of sedatives and in- remains the most popular sedative agent because of its rapid onset and emergent properties. 20,21,22 In Japan, propofol is off-label for sedation outside the operating room and is used with caution due to reports regarding its association with some deaths in pediatric patients. 23 Contrastingly, our results revealed that oral triclofos sodium was the most commonly used sedative (51.7%).…”

Anesthesia service provision for MRI: A shift in the radiologist's approach would be helpful as well

“…In their article, the authors describe a shift to a TIVA combination of propofol and dexmedetomidine, eventually representing almost 50% of all anesthetic techniques. 1 While the overall rate of respiratory adverse events (AEs) or physiologic perturbations was low and major AEs were rare, the authors reported that volatile anesthesia compared with a TIVA technique was an independent predictor of AEs consistent with reports of increased AEs with inhalation compared with an iv induction and TIVA being associated with less perioperative airway reflex responsiveness including in an MRI setting. 2,3 Given the low percentage of volatile-only anesthesia reported (≤2.8%/year), the majority of anesthetics appear to have used a natural airway.…”

“…Data sharing is not applicable to this article as no new data were created or analyzed in this study. Kimmo Murto 1,2 Barry Smith 3,4 Leigh Banfield…”

“…Anesthesia service provision for MRI: A shift in the radiologist's approach would be helpful as well Dear Editor, We read with great interest the article by Vinson and colleagues reviewing trends over a 7-year period in MRI sedation/anesthesia based on a large and diverse pediatric cohort of mostly healthy 1-to 6-year-olds. 1 Their results detailed a rise in the use of a total intravenous anesthesia (TIVA) combination of propofol and dexmedetomidine and a concurrent 30% decrease in anesthesia/sedation administration using a "Try Without" approach with behavioral techniques and child-life specialists (personal communication Dr. AE Vinson). These findings are particularly timely, given the added risk of aerosolized-generating-medical-procedures (AGMPs) such as invasive airway management associated with Sars-Cov-2 and the backlog of pediatric MRIs created by this pandemic.…”

Anesthesia Service provision for MRI: Is shifting the technique enough?

“…In the current issue, Vinson and colleagues describe the change in anesthetic MRI regime over a 7-year period by retrospectively reviewing more than 24 000 anesthetics in a major pediatric tertiary hospital and analyzing the incidence of anesthesia-related adverse events (hypotension, bradycardia, and desaturation). 2 During the study period, propofol as sole agent (employed >60% of the time in 2013) was replaced by the combination propofol/dexmedetomidine (employed >45% of the time in 2019). The use of volatiles with propofol remained stable at 15% throughout the years, whereas the combination volatiles/propofol/dexmedetomidine became popular in 2019 (15% of the cases).…”