Shorrab Ahmed A, Demian Atef D, Atallah Mohamed M
Department of Anesthesia, Faculty of Medicine, University of Mansoura, Mansoura, Egypt.
Paediatr Anaesth. 2007 Dec;17(12):1187-93. doi: 10.1111/j.1460-9592.2007.02351.x.
We used a multidrug intravenous anesthesia regimen with midazolam, ketamine, and propofol to provide anesthesia for children during magnetic resonance imaging (MRI). This regimen was compared with general anesthesia in a randomized comparative study. Outcome measures were safety, side effects and recovery variables in addition to adverse events in relation to age strata.
The children received either general anesthesia with propofol, vecuronium and isoflurane [general endotracheal anesthesia (GET) group; n=313] or intravenous anesthesia with midazolam, ketamine, and propofol [intravenous anesthesia (MKP) group; n=342]. Treatment assignment was randomized based on the date of the MRI. Physiological parameters were monitored during anesthesia and recovery. Desaturation (SpO2<93%), airway problems, and the need to repeat the scan were recorded. The discharge criteria were stable vital signs, return to baseline consciousness, absence of any side effects, and ability to ambulate.
With the exception of two children (0.6%) in the MKP group, all enrolled children completed the scan. A significantly greater number (2.3%) required a repeat scan in the MKP group (P<0.05) and were sedated with a bolus dose of propofol. The total incidence of side effects was comparable between the MKP (7.7%) and GET groups (7.0%). Infants below the age of 1 year showed a significantly higher incidence of adverse events compared with the other age strata within each group. Within the MKP group, risk ratio was 0.40 and 0.26 when comparing infants aged below 1 year with the two older age strata, respectively. Recovery characteristics were comparable between both groups.
Intravenous midazolam, ketamine and propofol provides safe and adequate anesthesia, comparable with that obtained from general endotracheal anesthesia, for most children during MRI.
我们采用咪达唑仑、氯胺酮和丙泊酚的多药静脉麻醉方案，为儿童在磁共振成像（MRI）期间提供麻醉。在一项随机对照研究中，将该方案与全身麻醉进行了比较。除了与年龄层相关的不良事件外，结局指标还包括安全性、副作用和恢复变量。
儿童接受丙泊酚、维库溴铵和异氟醚全身麻醉[全身气管内麻醉（GET）组；n = 313]或咪达唑仑、氯胺酮和丙泊酚静脉麻醉[静脉麻醉（MKP）组；n = 342]。根据MRI检查日期进行随机分组。在麻醉和恢复期间监测生理参数。记录血氧饱和度降低（SpO2<93%）、气道问题以及重复扫描的必要性。出院标准为生命体征稳定、意识恢复至基线、无任何副作用以及能够行走。
除MKP组的两名儿童（0.6%）外，所有入选儿童均完成了扫描。MKP组中需要重复扫描的儿童数量显著更多（2.3%）（P<0.05），并给予了一剂丙泊酚进行镇静。MKP组（7.7%）和GET组（7.0%）的副作用总发生率相当。1岁以下婴儿与每组中的其他年龄层相比，不良事件发生率显著更高。在MKP组中，1岁以下婴儿与两个较大年龄层相比，风险比分别为0.40和0.26。两组的恢复特征相当。
对于大多数儿童在MRI期间，静脉注射咪达唑仑、氯胺酮和丙泊酚可提供安全且充分的麻醉，与全身气管内麻醉相当。
