ORIGINAL ARTICLES  ANESTHESIA Free access

Minerva Anestesiologica 2004 January-February;70(1-2):53-61

Copyright © 2003 EDIZIONI MINERVA MEDICA

language: English, Italian

Deep sedation for magnetic resonance imaging. Personal experience

Marchi A. ¹, Orrù A. ¹, Manai M. E. ¹, Chelo C. ², Lettieri B. ³, Corbucci G. G. ¹

¹ Department of Anesthesiology and Resuscitation, University of Cagliari, Cagliari, Italy, 2 Department of Surgical Sciences and Organ Transplantation, University of Cagliari, Cagliari, Italy, 3 Department of Anesthesia and Resuscitation, II University of Naples, Naples, Italy

Aim. Precision in diag­nos­tic pro­ce­dure and exam­ina­tion of paed­i­at­ric ­patients ­often ­requires ­their abso­lute immo­bil­ity. Deep seda­tion has prov­en to be an excel­lent meth­od, allow­ing opti­mum tech­ni­cal qual­ity of MRI par­tic­u­lar­ly in young­er age ­groups. The aim of study is to demonstrate the possible application of deep sedation through the use of 2 safe and manageable drugs.
Methods. We care­ful­ly eval­u­at­ed and select­ed 82 ­patients (47 ­males and 35 ­females; aver­age age 5.4 ­years): ­they ­came ­from var­i­ous paed­i­at­rics depart­ments. Deep seda­tion was prac­ticed ­with:
Chloral ­hydrate (60-80 mg/kg in one ­oral admin­is­tra­tion); propofol as intra­ve­nous ­bolus (2-2.5 mg/kg) fol­lowed by a main­te­nance infu­sion of 75-125 µg/kg/min. This was pre­ced­ed by mid­az­o­lam (0.05 mg/kg i.v.) out­side the MRI ­room. Oxygen sat­u­ra­tion (SpO2) was mon­i­tored in all ­patients ­along ­with ­heart ­rate in ­order to fore­see the ­need for any pos­sible ther­a­peu­tic inter­ven­tion.
Results. The seda­tion lev­els ­attained per­mit­ted the suc­cess of MRI assur­ing the immo­bil­iza­tion ­required. Manually assist­ed ­mask ven­ti­la­tion was ­required for a peri­od of 2-3 min in 5 ­patients treat­ed ­with pro­pof­ol. All oth­er ­patients ­breathed auton­o­mous­ly. Complete reawak­en­ing ­occurred with­in 2 ­hours of ­drug admin­is­tra­tion. Surveillance was pro­longed ­inside ­their respec­tive ­units, how­ev­er, with­out reg­is­ter­ing ­delayed ­side ­effects.
Conclusion. The cen­tral ­point of the suc­cess of ­deep seda­tion is to ­define the ­type and ­dose of opti­mum ­drug for indi­vid­u­al ­patients. This ­requires a qual­i­fied, ­expert ­equipe ­ready to inter­vene in the pres­ence of ­adverse ­results of ­drugs admin­is­tered. Propofol and chlor­al ­hydrate are the opti­mum ­drugs for diag­nos­tic tech­niques requir­ing ­total immo­bil­iza­tion and rap­id reawak­en­ing.