Sedation of children undergoing magnetic resonance imaging
Editor—As a consultant anaesthetist with a regular ‘paediatric MRI under anaesthesia’ list, I read the paper by Sury and Fairweather1 with great interest. I use a sevoflurane inhalation induction followed by i.v. cannulation. A laryngeal mask airway facilitates spontaneous respiration with sevoflurane and nitrous oxide. Comprehensive anaesthetic monitoring is used throughout. In my experience of over 200 cases, the advantages of this approach over sedation techniques are, I suggest:A single visit to the hospital regardless of the child's ‘cooperation level’.No necessity for awake, tearful needles.
Predictably rapid time to readiness and scan time—optimal scanner utilization.
Guaranteed completion of high diagnostic quality scans with minimal movement artifact.
Safety for unconscious children in a remote setting.
I therefore disagree with their concluding paragraph. ‘Efficiency’ is not the sole reason why so many units prefer general anaesthesia. I suspect ‘quality’ is the main consideration.
Kings Lynn, UK
Editor—Thank you for the opportunity to respond to Dr Allen's comments. Quality, defined as how good or bad something is, is a matter of opinion. Many parents prefer sedation delivered by mouth—provided it is successful—because their children dislike both inhalational and i.v. inductions. Neither the time taken for scan readiness, nor scanner utilization are quality issues for individual patients; indeed they are both measures of efficiency. Nevertheless I accept that a single visit to gain predictable anaesthesia and perfect imaging is a higher quality experience than difficult or failed sedation (not forgetting that anaesthesia inductions can also be difficult). The safety of a particular technique is largely dependent upon the practitioner. Sedation should be safe enough provided the judgement and skills of the sedationist are satisfactory. I think it is highly unlikely that there are good data to support the widely held view by anaesthetists that anaesthesia is safer than sedation for MRI in children. Certainly, in our experience of sedating over 6000 children for MRI, we have not had a serious airway incident whereas I doubt that I could anaesthetize a similar cohort without there being several potentially life-threatening cases of laryngospasm. It is important to emphasize that our children were selected—that is sedated children are healthier than those selected for anaesthesia. Notwithstanding all these thoughts, most hospitals will use anaesthetists for MRI if they have enough of them.
London, UK
E-mail: surym{at}gosh.nhs.uk
Reference
1 Sury MRJ and Fairweather K. The effect of melatonin on sedation of children undergoing magnetic resonance imaging. Br J Anaesth 2006; 97:220–5
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