Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
Department of Emergency Medicine, Rhineland Clinic, Hospital Dormagen, Dormagen, Germany.
Paediatr Anaesth. 2022 Aug;32(8):907-915. doi: 10.1111/pan.14461. Epub 2022 Apr 27.
Many different sedation concepts for magnetic resonance imaging have been described for prematurely and term-born infants, ranging from "no sedation" to general anesthesia. Dexmedetomidine is an alpha-2 receptor agonist that is frequently used to sedate older children, because the anesthesiologist can easily adjust sedation depth, the patient maintains spontaneous breathing, and awakens rapidly afterwards.
The present study evaluates whether dexmedetomidine could safely be used as the sole sedative for prematurely and term-born infants less than 60 weeks postconceptional age undergoing diagnostic procedures.
We performed a retrospective monocentric analysis of n = 39 prematurely and term-born infants (<60 weeks postconceptional age or a body weight <5 kg) who were sedated with dexmedetomidine for an MRI at a German university hospital from August 2016 to November 2018.
Successful imaging was achieved in all cases. The median initial bolus of dexmedetomidine administered over 10 min was 1.39 μg kg body weight (range 0.34-3.64 μg kg ), followed with a continuous infusion at a median rate of 1.00 μg kg h (range 0.5-3.5 μg kg h ); however, 3 patients (7%) needed some additional sedation (ketamine or propofol). All patients, including 10 infants who had previously required respiratory support, underwent the procedure without any relevant desaturation or apnea. Bradycardia was observed in up to 15 out of 39 cases (38.5%), but only four (10.3% in total and 26.7% of bradycardia) required atropine.
These results indicate that dexmedetomidine can be safely used for procedural sedation in the high-risk cohort of prematurely and term-born infants less than 60 weeks postconceptional age. Apnea during procedural sedation and subsequent stay in the recovery room is avoided, but bradycardia remains a relevant risk that may require treatment.
许多不同的磁共振成像镇静概念已被描述用于早产儿和足月儿，范围从“无镇静”到全身麻醉。右美托咪定是一种α-2 受体激动剂，常用于镇静年龄较大的儿童，因为麻醉师可以轻松调整镇静深度，患者保持自主呼吸，随后快速苏醒。
本研究评估右美托咪定是否可安全用作接受诊断性检查的小于 60 孕周的早产儿和足月儿 (<60 孕周或体重 <5kg) 的唯一镇静剂。
我们对 2016 年 8 月至 2018 年 11 月在德国一家大学医院接受 MRI 检查的 n=39 名早产儿和足月儿 (<60 孕周或体重 <5kg) 进行了回顾性单中心分析，这些婴儿使用右美托咪定镇静。
所有病例均成功成像。中位数初始右美托咪定负荷剂量为 1.39μg/kg 体重（范围 0.34-3.64μg/kg），持续输注速度为 1.00μg/kg 体重 h（范围 0.5-3.5μg/kg 体重 h）；然而，有 3 名患者（7%）需要额外镇静（氯胺酮或异丙酚）。所有患者，包括 10 名以前需要呼吸支持的婴儿，均在无任何相关低氧血症或呼吸暂停的情况下进行了该程序。多达 15/39 例（38.5%）出现心动过缓，但只有 4 例（总 10.3%和心动过缓的 26.7%）需要使用阿托品。
这些结果表明，右美托咪定可安全用于小于 60 孕周的早产儿和足月儿高危人群的程序镇静。避免了镇静期间的呼吸暂停和随后在恢复室的停留，但心动过缓仍然是一个相关的风险，可能需要治疗。
