Aim To compare the outcome of sole dexmedetomidine or with other sedative drugs in paediatric patients during magnetic resonance imaging (MRI). Methods Literature was obtained from PubMed and ScienceDirect from 2010-2020 using key words: sedation, paediatric, dexmedetomidine, ambulatory, MRI, ketamine, propofol, midazolam. The literature selection was based on Participant, Intervention, Comparators, Outcomes (PICO) analysis. All English full-text and peer-reviewed articles were included. The primary outcome was hemodynamic stability, respiratory compromise, and recovery time. The risk of bias analysis was assessed using Cochrane collaboration Risk of Bias (RoB 2.0). Result Of 106 studies, 17 studies were included with a total 3.430 paediatric patients undergoing MRI. Dexmedetomidine alone provides a more stable hemodynamic but longer recovery time than ketamine, propofol or midazolam. The combination of dexmedetomidine and ketamine provides more stable hemodynamics, especially in the incidence of hypotension and bradycardia, and does not significantly reduce airway configuration more than sole dexmedetomidine or ketamine. Intranasal dexmedetomidine is more recommended than its combination with midazolam. Combining dexmedetomidine with ketamine, propofol or midazolam provides a shorter recovery time. Conclusion A combination of dexmedetomidine with other sedatives such as ketamine, propofol and midazolam is better than sole dexmedetomidine for paediatric sedation during magnetic resonance imaging.
Tervonen M, Pokka T, Kallio M, Peltoniemi O. Systematic review and meta-analysis found that intranasal dexmedetomidine was a safe and effective sedative drug during paediatric procedural sedation. Acta Paediatr Int J Paediatr. 2020;2008–16.
2.
Ramalho C, Bretas P, Schvartsman C, Reis A. Sedation and analgesia for procedures in the pediatric. J Pediatr (Rio J). 2017;2–18.
3.
Jung S. Drug selection for sedation and general anesthesia in children undergoing ambulatory magnetic resonance imaging. Yeungnam Univ J Med. 2020;159–68.
4.
Blüml S, Panigrahy A. MR Spectroscopy of Pediatric Brain Disorders. 2012;
5.
Godwin S, Caro D, Wolf S, Jagoda A, Charles R, Marett B, et al. American College of Emergency Physicians. Clinical policy: procedural sedation and analgesia in the emergency department. Ann Emerg Med. 2005;177–96.
6.
Coté C, Wilson S, Casamassimo P, Crumrine P, Gorman R, Hegenbarth M, et al. Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures: An update. Pediatrics. 2006;2587–602.
7.
Mahajan C, Dash H. Procedural sedation and analgesia in pediatric patients. J Pediatr Neurosci. 2014;1–6.
8.
Miller A, Theodore D, Widrich J. Inhalational Anesthetic. 2021;
9.
Weerink M, Struys M, Hannivoort L, Barends C, Absalom A, Colin. Clinical pharmacokinetics and pharmacodynamics of dexmedetomidine. Clin Pharmacokinet. 2017;893–913.
10.
Ma L, Wang Y, Yang Z, Huang D, Weng H, Zeng X. Methodological quality (risk of bias) assessment tools for primary and secondary medical studies: what are they and which is better. Military Med Res. 2020;1–11.
11.
Olgun G, Ali M. Use of intranasal dexmedetomidine as a solo sedative for MRI of infants. Hosp Pediatr. 2018;68–71.
12.
Balasubramanian B, Kulkarni S. A non-randomized controlled study of total intravenous anesthesia regimens for magnetic resonance imaging studies in children. J Anaesthesiol Clin Pharmacol. 2019;379–85.
13.
Sulton C, Kamat P, Mallory M, Reynolds J. The Use of intranasal dexmedetomidine and midazolam for sedated magnetic resonance imaging in children: a report from the Pediatric Sedation Research Consortium. Pediatr Emerg Care. 2020;138–42.
14.
Boriosi J, Eickhoff J, Hollman G. Safety and efficacy of buccal dexmedetomidine for MRI sedation in school-aged children. Hosp Pediatr. 2019;348–54.
15.
Nagoshi M, Reddy S, Bell M, Cresencia A, Margolis R, Wetzel R, et al. Low-dose dexmedetomidine as an adjuvant to propofol infusion for children in MRI: a double-cohort study. Paediatr Anaesth. 2018;639–46.
16.
Tammam T. Comparison of the efficacy of dexmedetomidine, ketamine, and a mixture of both for pediatric MRI sedation. Egypt J Anaesth. 2013;241–6.
17.
Abulebda K, Louer R, Lutfi R, Ahmed S. A Comparison of safety and efficacy of dexmedetomidine and propofol in children with autism and autism spectrum disorders undergoing magnetic resonance imaging. J Autism Dev Disord. 2018;3127–32.
18.
Ahmed S, Unland T, Slaven J, Nitu M. Dexmedetomidine versus propofol: is one better than the other for MRI sedation in children? J Pediatr Intensive Care. 2016;117–22.
19.
Eldeek A, Elfawal S, Allam M. Sedation in children undergoing magnetic resonance imaging comparative study between dexmedetomidine and ketamine. Egypt J Anaesth. 2016;263–8.
20.
Mylavarapu G, Fleck R, Ok M, Ding L, Kandil A, Amin R, et al. Effects on the upper airway morphology with intravenous addition of ketamine after dexmedetomidine administration in normal children. J Clin Med. 2020;1–14.
21.
Mahmoud M, Jung D, Salisbury S, Mcauliffe J, Gunter J, Patio M, et al. Effect of increasing depth of dexmedetomidine and propofol anesthesia on upper airway morphology in children and adolescents with obstructive sleep apnea. J Clin Anesth. 2013;529–41.
22.
Watt S, Sabouri S, Hegazy R, Gupta P, Heard C. Does dexmedetomidine cause less airway collapse than propofol when used for deep sedation. J Clin Anesth. 2016;259–67.
23.
Tang Y, Meng J, Zhang X, Li J, Zhou Q. Comparison of dexmedetomidine with propofol as sedatives for pediatric patients undergoing magnetic resonance imaging: a meta-analysis of randomized controlled trials with trial sequential analysis. Exp Ther Med. 2019;1775–85.
24.
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;102468–73.
25.
Gupta A, Dalvi N, Tendolkar B. Comparison between intranasal dexmedetomidine and intranasal midazolam as premedication for brain magnetic resonance imaging in pediatric patients: a prospective randomized double blind trial. J Anaesthesiol Clin Pharmacol. 2017;236–40.
26.
Trevisan M, Romano S, Bruno B, Murru I, Cozzi F, G. Intranasal dexmedetomidine and intravenous ketamine for procedural sedation in a child with alpha-mannosidosis: a magic bullet? Ital J Pediatr. 2019;1–6.
27.
Zhang W, Fan Y, Zhao T, Chen J, Zhang G, Song X. Median effective dose of intranasal dexmedetomidine for rescue sedation in pediatric patients undergoing magnetic resonance imaging. Anesthesiology. 2016;1130–5.
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