Various anesthetic regimens for pediatric magnetic resonance imaging, does one size fits all?

Background: Children are often required to hold their breath and stay still for longer period of time during magnetic resonance imaging (MRI), and therefore need to be sedated. Objective: Based on an analysis of our MRI sedation practice, we aimed to determine wether a uniform anesthetic regimen could be used in all pediatric patients for this purpose. Material/Methods: We retrospectively reviewed 148 MRI sedations performed over the last year using anesthesia charts and we compared sedations before and after the introduction of dexmedetomidine at our clinic. We analyzed biodata, types of drugs used, body region scanned, and image quality. Results: The majority of our patients was <7 years and had an ASA status III. In the first half of the analyzed period general anesthesias with sevoflurane and I-gel laryngeal mask placement were most commonly performed (73,6%) in patients of all ages, with good imaging results and no complications. The rest of the patients were deeply sedated with various regimens using the combination of ketamine/ propofol (11,3%), chloral hydrate/ketamine (3,8%), midazolam/ketamine (7,5%) with a highly variable quality of image and duration of procedure. In the second half of the analyzed period, dexmedetomidine was used in 42,9% of cases mainly in children with a mean age of 3,6 years and without any significant complications and good imaging results. This drug seemed to have eliminated the need for other intravenous anesthetic combinations previously used for sedation, but was not useful during abdominal scans with breath holding. General anesthesias remained frequent (54,%), especially for the imaging of abdominal region, for children with cardiac comorbidities and young age. Conclusions: Based on our experience a uniform anesthetic regimen cannot be used in all patients, and the choice should be influenced by the comorbidities of the patients and upon the body region which is being scanned.