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Sedation of Children for MRI examination
- Amr Mohamed Elsayed Abdelaal, Oliver Dearlove (22 June 2005)
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Amr Mohamed Elsayed Abdelaal, Anaesthetic SpR Royal Manchester Children Hospital, Oliver Dearlove
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Dear Sir, We have read with interest the study by Koroglu et al.1 in which Dexmedetomidine was compared to midazolam as a sedative in children undergoing MRI examination. However, we wish to make a number of points: Presedation behaviour was assessed on a four point scale (1=calm and cooperative, 2=anxious but reassurable, 3=anxious and not reassurable, 4=crying or resisting). The validity of this assessment is very subjective and has not been tested against any gold standard such as mYPAS. In addition, it could easily miss the children that appear calm from the outside but are in fact extremely anxious on the inside 2. A Ramsay score of 6 counts as anaesthetised to us. To aim for a Ramsay score of 6 as a sedation score is quite unsafe especially in an isolated environment such as an MRI where a difficulty might be encountered in directly accessing the patients. We did not the see the benefit of sedation in term of quick recovery, as the recovery of the study patients was comparable to the recovery after general anaesthetic if not longer. Also bearing in mind the many adverse events published in the literature following sedation as heavy as this 3 4, and we wonder if it would be much safer to go for a formal general anaesthetic. While we do appreciate the benefits of both drugs when used as an infusion for sedation in Intensive Care, the fact that dexmedetomidine has a context sensitive half life ranging from 4 minutes to 250 minutes depending on the length of time of the infusion leads us to question the appropriateness of using them as continuous infusion in procedure where rapid recovery is expected, especially if the procedure time extends beyond what was originally anticipated 5. The same applies to midazolam when used as an infusion or multiple doses in that it will result in delayed awakening 6. Koroglu’s study compares like with like, however there also has to be a comparison with current practice. We are not aware of anyone using midazolam infusions for sedation for magnetic resonance imaging. We therefore do not think that this study will lead to a change in practice in sedation for MRI scanning which is at present tending toward consultant-supervised, nurse-delivered. 1. Koroglu A, Demirbilek S, Teksan H, Sagir O, But AK, Ersoy MO. Sedative, haemodynamic and respiratory effects of dexmedetomidine in children undergoing magnetic resonance imaging examination: preliminary results. Br J Anaesth 2005;94(6):821-4. 2. Kain ZN, Mayes LC, Cicchetti DV, Bagnall AL, Finley JD, Hofstadter MB. The Yale Preoperative Anxiety Scale: how does it compare with a "gold standard"? Anesth Analg 1997;85(4):783-8. 3. Cote CJ, Karl HW, Notterman DA, Weinberg JA, McCloskey C. Adverse sedation events in pediatrics: analysis of medications used for sedation. Pediatrics 2000;106(4):633-44. 4. Cote CJ, Notterman DA, Karl HW, Weinberg JA, McCloskey C. Adverse sedation events in pediatrics: a critical incident analysis of contributing factors. Pediatrics 2000;105(4 Pt 1):805-14. 5. Venn RM, Karol MD, Grounds RM. Pharmacokinetics of dexmedetomidine infusions for sedation of postoperative patients requiring intensive caret. Br J Anaesth 2002;88(5):669-75. 6. Theil DR, Stanley TE, 3rd, White WD, Goodman DK, Glass PS, Bai SA, et al. Midazolam and fentanyl continuous infusion anesthesia for cardiac surgery: a comparison of computer-assisted versus manual infusion systems. J Cardiothorac Vasc Anesth 1993;7(3):300-6. Yours sincerely Oliver Dearlove, MB BChir, FRCA Amr Abdelaal, MD, FRCA Royal Manchester Children Hospital oliverdearlove@btinternet.com amro@doctors.org.uk Conflict of Interest:None declared |
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