Tug Aslihan, Hanci Ayse, Turk Hacer Sebnem, Aybey Ferda, Isil Canan Tulay, Sayin Pinar, Oba Sibel
Algology Department, Istanbul Medical Faculty, Istanbul University, Millet Cad., Çapa/Istanbul, Turkey.
Anesthesiology and Reanimation Department, Sisli Hamidiye Etfal Education and Research Hospital, Halaskargazi Cad. Etfal Sok., Sisli/Istanbul, Turkey.
Paediatr Drugs. 2015 Dec;17(6):479-85. doi: 10.1007/s40272-015-0145-1.
Anaesthetic agents used for magnetic resonance imaging (MRI) in paediatric patients should cause few adverse effects and allow fast anaesthetic induction and recovery. The administration route is also important and should be minimally invasive. In this study, we aimed to compare two different doses of intranasal dexmedetomidine applied to children for MRI sedation.
Sixty patients between 1 and 10 years of age with American Society of Anesthesiologists Physical Status classification I or II who were scheduled for MRI were recruited into this prospective, randomized, double-blind study. Intranasal dexmedetomidine was administered at doses of 3 µg kg(-1) (Group 1) and 4 µg kg(-1) (Group 2) before imaging. Heart rate (HR), peripheral oxygen saturation, respiratory rate and Ramsay Sedation Scale (RSS) scores were recorded before the anaesthetic induction of sedation and every 10 min until discharge. If intranasal sedation failed, an intravenous cannula was placed and propofol was applied as a rescue anaesthetic. Bispectral Index (BIS) scores were also recorded before and after MRI. We recorded onset time of sedation, mood at separation from parents (defined as parental separation score), imaging quality, MRI duration, rescue anaesthetic requirement, total duration of sedation, recovery duration, parents' satisfaction and adverse effects.
The results related to age, weight and adverse effects were not statistically different between the groups. The parental separation score was significantly higher in Group 2 (P = 0.003). Rescue anaesthetic requirement was significantly higher in Group 1 (P = 0.002). The results related to recovery duration, MRI duration, parents' satisfaction, onset time of sedation and total duration of sedation were not statistically different. HR was significantly lower in all time intervals compared with basal values in both groups. In Group 2, RSS scores were significantly higher in the 30th, 40th and 50th min. The BIS scores in Group 2 were lower at the 50th min. Neither bradycardia nor oxygen desaturation were observed. Imaging studies were completed successfully in all patients.
Based on lower rescue anaesthetic requirements, sufficient sedation and parental separation scores in Group 2, intranasal dexmedetomidine 4 µg kg(-1) was more efficient than intranasal dexmedetomidine 3 µg kg(-1). The intranasal route may be an alternative noninvasive route to apply drugs for MRI sedation in paediatric patients. Trial registration ClinicalTrials.gov: NCT02299232.
用于儿科患者磁共振成像（MRI）的麻醉药物应引起较少的不良反应，并能实现快速麻醉诱导和苏醒。给药途径也很重要，应尽量微创。在本研究中，我们旨在比较两种不同剂量的鼻内右美托咪定用于儿童MRI镇静的效果。
将60例年龄在1至10岁、美国麻醉医师协会身体状况分级为I或II级且计划接受MRI检查的患者纳入这项前瞻性、随机、双盲研究。在成像前，分别以3 μg/kg（第1组）和4 μg/kg（第2组）的剂量给予鼻内右美托咪定。在镇静麻醉诱导前以及直至出院前每隔10分钟记录心率（HR）、外周血氧饱和度、呼吸频率和 Ramsay 镇静评分（RSS）。如果鼻内镇静失败，则放置静脉套管并给予丙泊酚作为抢救麻醉。在MRI检查前后也记录脑电双频指数（BIS）评分。我们记录了镇静起效时间、与父母分离时的情绪（定义为父母分离评分）、成像质量、MRI持续时间、抢救麻醉需求、总镇静持续时间、苏醒持续时间、父母满意度和不良反应。
两组之间在年龄、体重和不良反应方面的结果无统计学差异。第2组的父母分离评分显著更高（P = 0.003）。第1组的抢救麻醉需求显著更高（P = 0.002）。在苏醒持续时间、MRI持续时间、父母满意度、镇静起效时间和总镇静持续时间方面的结果无统计学差异。与两组的基础值相比，所有时间间隔的HR均显著降低。在第2组中，第30、40和50分钟时RSS评分显著更高。第2组在第50分钟时BIS评分更低。未观察到心动过缓或氧饱和度降低。所有患者的成像研究均成功完成。
基于第2组较低的抢救麻醉需求、充分的镇静效果和父母分离评分，4 μg/kg的鼻内右美托咪定比3 μg/kg的鼻内右美托咪定更有效。鼻内途径可能是儿科患者用于MRI镇静给药的一种替代性非侵入性途径。试验注册ClinicalTrials.gov：NCT02299232。
