Li Bi Lian, Luo Hao, Huang Jun Xiang, Zhang Huan Huan, Paquin Joanna R, Yuen Vivian M, Song Xing Rong
Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
Front Pediatr. 2022 Aug 4;10:889369. doi: 10.3389/fped.2022.889369. eCollection 2022.
Although numerous intravenous sedative regimens have been documented, the ideal non-parenteral sedation regimen for magnetic resonance imaging (MRI) has not been determined. This prospective, interventional study aimed to investigate the efficacy and safety of buccal midazolam in combination with intranasal dexmedetomidine in children undergoing MRI.
Children between 1 month and 10 years old requiring sedation for MRI examination were recruited to receive buccal midazolam 0.2 mg⋅kg with intranasal dexmedetomidine 3 μg⋅kg. The primary outcome was successful sedation following the administration of the initial sedation regimens and the completion of the MRI examination.
Sedation with dexmedetomidine-midazolam was administered to 530 children. The successful sedation rate was 95.3% (95% confidence interval: 93.5-97.1%) with the initial sedation regimens and 97.7% (95% confidence interval: 96.5-99%) with a rescue dose of 2 μg⋅kg intranasal dexmedetomidine. The median sedation onset time was 10 min, and a significant rising trend was observed in the onset time concerning age ( = 0.2491, < 0.001). The wake-up and discharge times significantly correlated with the duration of the procedure ( = 0.323, < 0.001 vs. = 0.325, < 0.001). No oxygen deficiency nor medication intervention due to cardiovascular instability was observed in any of the patients. History of a prior failed sedation was considered a statistically significant risk factor for failed sedation in the multivariate logistic regression model [odds ratio = 4.71 (95% confidence interval: 1.24-17.9), = 0.023].
In MRI examinations, the addition of buccal midazolam to intranasal dexmedetomidine is associated with a high success rate and a good safety profile. This non-parenteral sedation regimen can be a feasible and convenient option for short-duration MRI in children between 1 month and 10 years.
尽管已有众多静脉镇静方案的记录，但用于磁共振成像（MRI）的理想非肠道镇静方案尚未确定。这项前瞻性干预研究旨在调查口服咪达唑仑联合鼻内右美托咪定在接受MRI检查的儿童中的有效性和安全性。
招募1个月至10岁因MRI检查需要镇静的儿童，给予口服咪达唑仑0.2mg·kg及鼻内右美托咪定3μg·kg。主要结局是在给予初始镇静方案后及完成MRI检查后成功镇静。
530名儿童接受了右美托咪定 - 咪达唑仑镇静。初始镇静方案的成功镇静率为95.3%（95%置信区间：93.5 - 97.1%），鼻内右美托咪定2μg·kg的挽救剂量的成功镇静率为97.7%（95%置信区间：96.5 - 99%）。中位镇静起效时间为10分钟，且观察到起效时间与年龄呈显著上升趋势（= 0.2491，< 0.001）。苏醒和出院时间与检查过程持续时间显著相关（= 0.323，< 0.001与= 0.325，< 0.001）。所有患者均未观察到因心血管不稳定导致的缺氧或药物干预。在多因素逻辑回归模型中，既往镇静失败史被认为是镇静失败的统计学显著危险因素[比值比 = 4.71（95%置信区间：1.24 - 17.9），= 0.023]。
在MRI检查中，鼻内右美托咪定联合口服咪达唑仑具有高成功率和良好的安全性。这种非肠道镇静方案对于1个月至10岁儿童的短时间MRI检查可能是一种可行且方便的选择。
