Pershad Jay, Wan Jim, Anghelescu Doralina L
Division of Emergency Medicine, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN 38103, USA.
Pediatrics. 2007 Sep;120(3):e629-36. doi: 10.1542/peds.2006-3108. Epub 2007 Aug 14.
Propofol and pentobarbital, alone or combined with other agents, are frequently used to induce deep sedation in children for MRI. However, we are unaware of a previous comparison of these 2 agents as part of a randomized, controlled trial. We compared the recovery time of children after deep sedation with single-agent propofol with a pentobarbital-based regimen for MRI and considered additional variables of safety and efficacy.
This prospective, randomized trial at a tertiary children's hospital enrolled 60 patients 1 to 17 years old who required intravenous sedation for elective cranial MRI. Patients were assigned randomly to receive a loading dose of propofol followed by continuous intravenous infusion of propofol or to receive sequential doses of midazolam, pentobarbital, and fentanyl until a modified Ramsay score of >4 was attained. A nurse who was blind to group assignment assessed discharge readiness (Aldrete score > 8) and administered a follow-up questionnaire. We compared recovery time, time to induction of sedation, total sedation time, quality of imaging, number of repeat-image sequences, adverse events, caregiver satisfaction, and time to return to presedation functional status.
The groups were similar in age, gender, race, American Society of Anesthesiology physical status class, and frequency of cognitive impairment. No sedation failure or significant adverse events were observed. Propofol offered significantly shorter sedation induction time, recovery time, total sedation time, and time to return to baseline functional status. Caregiver satisfaction scores were also significantly higher in the patients in the propofol group.
Propofol permits faster onset and recovery than, and comparable efficacy to, a pentobarbital/midazolam/fentanyl regimen for sedation of children for MRI.
丙泊酚和戊巴比妥单独使用或与其他药物联合使用，常用于诱导儿童在磁共振成像（MRI）检查时深度镇静。然而，我们尚未知晓这两种药物在随机对照试验中的比较情况。我们比较了单药丙泊酚与基于戊巴比妥的方案用于儿童MRI深度镇静后的恢复时间，并考虑了安全性和有效性的其他变量。
在一家三级儿童医院进行的这项前瞻性随机试验纳入了60例1至17岁因择期头颅MRI需要静脉镇静的患者。患者被随机分配接受丙泊酚负荷剂量，随后持续静脉输注丙泊酚，或接受咪达唑仑、戊巴比妥和芬太尼的序贯给药，直至改良Ramsay评分>4。一名对分组情况不知情的护士评估出院准备情况（Aldrete评分>8）并进行随访问卷调查。我们比较了恢复时间、镇静诱导时间、总镇静时间、成像质量、重复图像序列数量、不良事件、 caregiver满意度以及恢复到镇静前功能状态的时间。
两组在年龄、性别、种族、美国麻醉医师协会身体状况分级和认知障碍频率方面相似。未观察到镇静失败或重大不良事件。丙泊酚的镇静诱导时间、恢复时间、总镇静时间以及恢复到基线功能状态的时间明显更短。丙泊酚组患者的caregiver满意度评分也显著更高。
对于儿童MRI镇静，丙泊酚比戊巴比妥/咪达唑仑/芬太尼方案起效更快、恢复更快，且疗效相当。
