Pediatric Sedation/Anesthesia for MRI: Results From the Pediatric Sedation Research Consortium
Pediatric Sedation/Anesthesia for MRI: Results From the Pediatric Sedation Research Consortium
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DOI：
10.1002/jmri.28392
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发表时间：
2022-08-12
影响因子：
4.4
通讯作者：
Hertzog, James H.
中科院分区：
文献类型：
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作者：
Mallory, Michael D.;Travers, Curtis;Hertzog, James H.
背景磁共振成像(MRI)是儿童最常见的需要镇静/麻醉的成像程序。了解与镇静/麻醉相关的不良事件对于决定MRI与其他成像方法的优劣很重要。目前还没有大型研究评估各种儿科专家对磁共振成像的儿科镇静/麻醉实践。目的利用大型儿科镇静数据库为儿科MRI确定患者的特征和与镇静/麻醉相关的不良事件。研究类型：前瞻性收集数据的回顾分析。主题儿科镇静研究联盟(PSRC)从2011年11月10日到2017年12月18日有109,947个用于MRI的镇静剂条目。评估患者的人口统计、镇静药物、干预措施和不良事件都有描述。评估与不良事件的相关性。随着时间的推移，镇静药物的使用趋势也得到了检验。统计检验采用描述性统计、卡方检验和费雪精确检验分类变量、Logistic回归和趋势估计等方法。结果共检查了109,947个与MRI相关的镇静剂。大多数受试者(66.2%)年龄在5岁或以下。在63.7%的病例中，癫痫发作或其他神经问题促使MRI。负责镇静/麻醉的提供者包括重症医生(49.3%)、急诊内科医生(28.2%)、住院医生(10.2%)和麻醉师(9.8%)。最常用的镇静剂是异丙酚(89.1%)。最常见的呼吸道干预是补充氧气(71.7%)，其次是头部/呼吸道重新定位(20.6%)。8.4%的患者发生了与呼吸道相关的不良事件。仅0.06%的患者发生严重不良事件，包括3例心脏骤停。没有死亡记录。随着时间的推移，右美托咪定的使用在统计学上有显著的增加。数据结论总体而言，不良事件发生率较低。使用异丙酚输注和自然气道的镇静/麻醉是这一不同的镇静提供者最常用的方法。右美托咪定的使用量随着时间的推移而增加。证据级别4技术效能阶段5
Background Magnetic resonance imaging (MRI) is the most common imaging procedure requiring sedation/anesthesia in children. Understanding adverse events associated with sedation/anesthesia is important in making decisions regarding MRI vs. other imaging modalities. No large studies have evaluated the practice of pediatric sedation/anesthesia for MRI by a variety of pediatric specialists. Purpose Utilize a large pediatric sedation database to characterize the patients and adverse events associated with sedation/anesthesia for pediatric MRI. Study Type Retrospective analysis of prospectively collected data. Subjects The Pediatric Sedation Research Consortium (PSRC) has 109,947 entries for sedations for MRI from November 10, 2011 through December 18, 2017. Assessment Patient demographics, sedative medications, interventions, and adverse events are described. Associations with adverse events were assessed. Trends in sedative medications used over time are examined. Statistical Tests Descriptive statistics, Chi-Squared and Fisher's Exact tests for categorical variables, logistic regression and assessment of trend using logistic regression and other method. Results A total of 109,947 MRI-related sedations were examined. Most subjects (66.2%) were 5 years old or younger. Seizure or other neurologic issue prompted MRI in 63.7% of cases. Providers responsible for sedation/anesthesia included intensivists (49.3%), emergency medicine physicians (28.2%), hospitalists (10.2%), and anesthesiologists (9.8%). The most commonly used sedative agent was propofol (89.1%). The most common airway intervention was supplemental oxygen (71.7%), followed by head/airway repositioning (20.6%). Airway-related adverse events occurred in 8.4% of patients. Serious adverse events occurred in only 0.06% of patients, including three cases of cardiac arrest. No mortality was recorded. There was a statistically significant increase in the use of dexmedetomidine over time. Data Conclusions Overall, adverse event rates were low. Sedation/anesthesia with propofol infusion and natural airway was the most common method used by this varied group of sedation providers. The use of dexmedetomidine increased over time. Evidence Level 4 Technical Efficacy Stage 5