Use of Dexmedetomidine as an Adjuvant in Pediatric MRI Procedures

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Use of Dexmedetomidine as an Adjuvant in Pediatric MRI Procedures

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Introduction: The success of sedation for MRI has typically been measured by two factors: comfortable immobility during the procedure enabling successful completion of the diagnostic examination and the safety of the sedation procedure. We have tried to assess the role of Dexmedetomidine as an adjuvant in pediatric MRI procedures. Aims and Objectives: To assess the effectiveness of intravenous dexmedetomidine as an adjuvant to the combination of Ketamine and Midazolam in pediatric patients undergoing MRI study and to compare incidence and severity of adverse effects found in the groups with and without Dexmedetomidine. Materials and Methods: After obtaining ethical committee approval and consent from the parents, 60 children posted for MRI study of duration less than 60 minutes, of age group 6 months to 5 years were selected for the study purpose and randomly divided into two groups. Children under group A received Inj. Ketamine 2 mg/kg + Inj. Midazolam 0.05 mg/kg. Children under Group B received Inj. Ketamine 0.5 mg/kg + Inj. Midazolam 0.03 mg/kg + Inj. Dexmedetomidine 2 mcg/kg. Monitoring of SpO2, RR, HR were done with the help of MRI compatible monitors. 3-point score to assess grade of immobility during the procedure was used to assess the quality of sedation. Ramsay sedation score was used to assess duration of post-procedure sedation. Incidences of adverse events were noted. Inj. Propofol 0.5 mg/kg was used as rescue sedative and Inj. Atropine 0.02 mg/kg for treatment of bradycardia if any. All the patients received nasal Oxygen at 2 lt/min. Observations and Results: Movement during MRI procedure was noted in one patient from Group B. Postoperative Ramsay sedation scores were significantly higher >3 in 12 patients (40%) from Group A vs in 5 patients (16.7%) from Group B (p < 0.05). Intraprocedural quality of sedation was better with Group B (p < 0.05). 5.5% patients from group A desaturated within 10 min of administration of drugs which recovered spontaneously within 5 min of continuation of supplemental oxygen. Conclusion: Addition of Dexmedetomidine (2 mcg/kg) reduces doses of Midazolam and Ketamine hence reducing the incidence of dose related side effects without causing compromise in efficacy. It produces stable hemodynamics, better immobility during the procedure and enables early recovery from anesthesia.

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