Eker H Evren, Cok Oya Yalcin, Çetinkaya Bilin, Aribogan Anis
Department of Anesthesiology, Baskent University School of Medicine, Adana Research and Education Center, Dadaloglu Mah 4/A, 01250, Adana, Turkey.
Department of Pediatrics, Baskent University School of Medicine, Adana, Turkey.
J Anesth. 2017 Apr;31(2):206-211. doi: 10.1007/s00540-016-2296-9. Epub 2016 Dec 20.
Newborns are often sedated during MRI but sedation itself creates adverse events and management is more challenging in this environment. Oral glucose/sucrose administration has been studied in newborns during painful procedures; however, its effectiveness in keeping newborns sleepy and motionlessness during painless procedures has not been demonstrated. The objective of this study was to describe effectiveness of oral 30% glucose administration by comparing with intravenous midazolam sedation for newborns during MRI.
One hundred twelve ASA II-III newborns who required care in the ICU and were scheduled for MRI with sedation were included. Group I received 30% glucose solution orally with 0.5-1 ml increments up to 2 ml/3 kg doses and group II received intravenous 0.1 mg/kg midazolam with 0.05 mg/kg repetition. The procedure was considered satisfactory when MRI images were not disturbed by patient movement after oral glucose or intravenous midazolam administration. The efficiency of the techniques, additional dose and rescue sedation requirements, blood glucose levels following oral 30% glucose suckling and presence of adverse events were recorded.
Demographic data was similar between groups. The efficiency of the procedures were similar between groups (78.9%, in group I and 66.1%, in group II). The blood glucose levels were within normal range in group I whereas transient desaturation and apnea occurred in 8 neonates in group II (p = 0.006).
Oral 30% glucose administration for newborns during MRI is as effective as standard sedation protocol with midazolam. Thereby, we recommend and support the integration of this safe and reliable technique into routine practice for newborns during MRI.
新生儿在磁共振成像（MRI）检查期间常需进行镇静，但镇静本身会引发不良事件，且在此环境下的管理更具挑战性。口服葡萄糖/蔗糖已在新生儿进行疼痛性操作时进行了研究；然而，其在无痛操作期间使新生儿保持嗜睡和不动的有效性尚未得到证实。本研究的目的是通过比较口服30%葡萄糖与静脉注射咪达唑仑对新生儿MRI检查期间的镇静效果，来描述口服30%葡萄糖的有效性。
纳入112例在重症监护病房（ICU）需要护理且计划在镇静下进行MRI检查的美国麻醉医师协会（ASA）II-III级新生儿。第一组口服30%葡萄糖溶液，每次增量0.5-1 ml，直至剂量达到2 ml/3 kg，第二组静脉注射0.1 mg/kg咪达唑仑，并重复注射0.05 mg/kg。当口服葡萄糖或静脉注射咪达唑仑后MRI图像未因患者移动而受到干扰时，该操作被认为是令人满意的。记录技术效率、额外剂量和补救性镇静需求、口服30%葡萄糖吸吮后的血糖水平以及不良事件的发生情况。
两组之间的人口统计学数据相似。两组之间的操作效率相似（第一组为78.9%，第二组为66.1%）。第一组的血糖水平在正常范围内，而第二组有8例新生儿出现短暂性低氧血症和呼吸暂停（p = 0.006）。
新生儿MRI检查期间口服30%葡萄糖与标准的咪达唑仑镇静方案一样有效。因此，我们建议并支持将这种安全可靠的技术纳入新生儿MRI检查的常规操作中。
