Details
Category: Volume 07 Issue 05 May 2019
Hits: 1276

Title: Dexmedetomidine compared with propofol for paediatric patients requiring sedation for Magnetic Resonance imaging

Authors: Dr Naresh W Paliwal, Dr Jayesh Ingle, Dr Shital Dharamkhele

 DOI: https://dx.doi.org/10.18535/jmscr/v7i5.49

Abstract

Introduction: Magnetic resonance imaging is a highly precise diagnostic modality for the diagnosis of congenital as well as acquired pathologies in pediatric age group. The advantages of MRI include its high sensitivity and specificity for the diagnosis of various intracranial pathologies. Moreover, its devoid of any radiation exposure. One of the prerequisites for MRI imaging is that patient needs to remain still during the procedure otherwise movement artefact will be produced making the interpretation difficult. Dexmedetomidine and propofol can be used as sedatives in pediatric patients undergoing MRI. We conducted this comparative study to analyses the utility of Dexmedetomidine and propofol as sedating agent in pediatric patients undergoing MRI imaging.

Materials and Methods: This was a comparative study in which pediatric patients between 2 - 12 years and undergoing MRI imaging were included on the basis of a predefined inclusion and exclusion criteria. The study was conducted in anesthesiology department of a tertiary care medical college located in an urban area. Total 60 pediatric patients undergoing MRI and who required sedation were included int this study. Out of 60 cases 30 patients (Group A) were given Dexmedetomidine 1 μg/kg initial dose followed by infusion of 0.5 μg/kg/hr (if needed). Remaining 30 patients (Group B) patients received propofol 3 mg/kg initial dose followed by infusion of 100 μg/kg/min (if needed). Demographic dataof patients in both the groups was recorded and compared. Onset of sedation time, recovery time, duration of sedation and ability to reduce motion resulting into good quality MRI and any adverse event were compared. For statistical analysis SSPE 21.0 software was used and p value less than0.05 was taken as statistically significant.

Results: Out of 60 studied cases there were 42 males and 18 females with a M:F ratio of1:0.42. Mean age of the patients in group A and group B was 6.2 +/- 2.12 and 5.9 +/- 1.98 years. The age groups were found to be comparable (P>0.05). Mean onset of sedation time in group A and group B was 10.2 +/- 3.12and 3.82 +/- 1.90 minutes (P<0.05). Mean recovery time in group A and B was found to be 24 +/-14.24 and 14 +/- 3.92 (P<0.05). Mean time needed for MRI was 22 +/- 5.12 and 24 +/- 4.42 in group A and B respectively (P>0.05). Mean sedation time was found to be 42 +/- 12.22 and 44 +/-11.82 minutes in group A and B respectively (P>0.05). The incidence of pediatric anesthesia mergence delirium was found to be 2 and 3 patients in group A and B respectively.

Conclusion: Dexmedetomidine was found have late onset of sedation time and prolonged recovery time as compared to propofol in children requiring sedation for MRI. Mean sedation time was found to be comparable. The adverse events were more common with propofol as compared to dexmedetomidine.

Keywords: Dexmedetomidine, propofol, sedation, Magnetic resonance imaging.

References

  1. Grover VP, Tognarelli JM, Crossey MM, Cox IJ, Taylor-Robinson SD, McPhail MJ. Magnetic Resonance Imaging: Principles and Techniques: Lessons for Clinicians. J Clin Exp Hepatol. 2015;5(3):246–255.
  2. Ramalho M, Hithaya I, AlObaidy M, Kalubowila J, Jeon YH, Manikkavasakar S, Semelka RC. MRI Evaluation of cooperative and non-cooperative patients with non-traumatic acute abdominal pain - preliminary observations. Clin Imaging. 2016 Jul-Aug;40(4):707-13.
  3. Zaitsev M, Maclaren J, Herbst M. Motion artifacts in MRI: A complex problem with many partial solutions. J MagnReson Imaging. 2015;42(4):887–901.
  4. Thukral BB. Problems and preferences in pediatric imaging. Indian J Radiol Imaging. 2015;25(4):359–364.
  5. Arthurs OJ, Sury M. Anaesthesia or sedation for paediatric MRI: advantages and disadvantages. CurrOpinAnaesthesiol. 2013 Aug;26(4):489-94.
  6. Lawson GR. Controversy: Sedation of children for magnetic resonance imaging. Arch Dis Child. 2000 Feb;82(2):150-3. 
  7. Arlachov Y, Ganatra RH. Sedation/ anaesthesia in paediatric radiology. Br J Radiol. 2012;85(1019):e1018–e1031.
  8. Gertler R, Brown HC, Mitchell DH, Silvius EN. Dexmedetomidine: a novel sedative-analgesic agent. Proc (Bayl Univ Med Cent). 2001;14(1):13–21.
  9. Scheinin H, Virtanen R, MacDonald E, Lammintausta R, Scheinin M. Medetomidine--a novel alpha 2-adrenoceptor agonist: a review of it spharmacodynamic effects. Prog Neuropsychopharmacol Biol Psychiatry 1989;13(5):635-51.
  10. Giovannitti JA Jr, Thoms SM, Crawford JJ. Alpha-2 adrenergic receptor agonists: a review of current clinical applications. Anesth Prog. 2015;62(1):31–39.
  11. Naaz S, Ozair E. Dexmedetomidine in current anaesthesia practice- a review. J Clin Diagn Res. 2014;8(10):GE01–GE4.
  12. Plambech MZ, Afshari A. Dexmedetomidine in the pediatric population: a review. Minerva Anestesiol. 2015 Mar;81(3):320-32.
  13. Carney L, Kendrick J, Carr R. Safety and Effectiveness of Dexmedetomidine in the Pediatric Intensive Care Unit (SAD-PICU). Can J Hosp Pharm. 2013;66 (1):21–27.
  14. Kotani Y, Shimazawa M, Yoshimura S, Iwama T, Hara H. The experimental andclinical pharmacology of propofol, an anesthetic agent with neuroprotective properties. CNS Neurosci Ther. 2008 Summer;14(2):95-106.
  15. Kulkarni S, Harsoor SS, Chandrasekar M, et al. Consensus statement on anaesthesia for day care surgeries. Indian J Anaesth. 2017;61(2):110–124.
  16. Kamal K, Asthana U, Bansal T, Dureja J, Ahlawat G, Kapoor S. Evaluation of efficacy of dexmedetomidine versus propofol for sedation in children undergoing magnetic resonance imaging. Saudi journal of anaesthesia. 2017;11:163–168.
  17. Zhou Q, Shen L, Zhang X, Li J, Tang Y. Dexmedetomidine versus propofol on the sedation of pediatric patients during magnetic resonance imaging (MRI) scanning: a meta-analysis of current studies. Oncotarget. 2017;8(60):102468–102473. Published 2017 Nov 1.
  18. Fang H, Yang L, Wang X, Zhu H. Clinical efficacy of dexmedetomidine versus propofol in children undergoing magnetic resonance imaging: a meta-analysis. Int J Clin Exp Med. 2015;8:11881–11889.
  19. Peng K, Li J, Ji FH, Li Z. Dexmedetomidine compared with propofol for pediatric sedation during cerebral angiography. J Res Med Sci. 2014 Jun;19(6):549-54.
  20. John S, Somal J, Thebo U, Hussain MS, Farag E, Dupler S, Gomes J. Safety and Hemodynamic Profile of Propofol and Dexmedetomidine Anesthesia during Intra-arterial Acute Stroke Therapy. J Stroke Cerebrovasc Dis. 2015 Oct;24(10): 2397-403.

Corresponding Author

Dr Jayesh Ingle

Assistant Professor Department of Anesthesiology Dr.Panjabrao Deshmukh Memorial Medical College, Amravati (MS)- India