Anesthesia (sedation) selecting algorithm ensuring magnetic resonance imaging in children with neurological disorders

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OBJECTIVE

To develop anesthesia (sedation) selecting algorithm in children with neurological disorders undergoing magnetic resonance imaging.

MATERIAL AND METHODS

We have retrospectively analyzed anesthesia protocols during magnetic resonance imaging without contrast enhancement in patients with neurological pathology. Four methods of anesthesia were studied: inhalation anesthesia with sevoflurane and midazolam intranasal premedication, inhalation anesthesia with sevoflurane and intravenous administration of propofol, monoanesthesia with sevoflurane as a control group; intranasal sedation with dexmedetomidine in neuromuscular pathology. For each patient, parameters of cardiovascular and respiratory systems, patient’s response to induction according to Mask acceptance scale, awakening time according to modified Aldrete scale, incidence and severity of post-anesthetic agitation according to Watcha scale were evaluated.

RESULTS

Intranasal sedation with dexmedetomidine ensures magnetic resonance imaging lasting up to 1 hour in children with neuromuscular pathology. Premedication with midazolam reduces the negative reaction to the mask and ensures comfortable induction. Propofol infusion at the end of anesthesia and premedication with midazolam did not significantly decrease the incidence of post-anesthetic agitation. However, severity of agitation was significantly reduced (p <0.01).

CONCLUSION

Intranasal sedation with dexmedetomidine is recommended for neuromuscular pathology. Inhalation anesthesia in combination with intranasal midazolam premedication is recommended if contraindications are absent. In case of negative reaction at induction, intravenous administration of propofol at the end of anesthesia is recommended in order to prevent post-anesthetic agitation.

Keywords:

magnetic resonance imaging

neurological pathology

children

agitation

neuromuscular pathology

Authors:

Yakovleva E.S.

Scientific and Practical Center for Pediatric Psychoneurology

Diordiev A.V.

Scientific and Practical Center for Pediatric Psychoneurology;
Pirogov Russian National Research Medical University

Adkina E.A.

Scientific and Practical Center for Pediatric Psychoneurology

Lazarev V.V.

Russian Children’s Clinical Hospital of the Pirogov Russian National Research Medical University;
Pirogov Russian National Research Medical University

ORCID: 0000-0001-8417-3555

Received:

17.06.2020

Accepted:

22.07.2020

List of references:

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