Propofol/Ketamine for Pediatric MRI Sedation
Trial question
What is the role of propofol/ketamine sedation in pediatric patients undergoing MRI?
Study design
Single center
Double blinded
RCT
Population
Characteristics of study participants
42.0% female
58.0% male
N = 107
107 patients (45 female, 62 male).
Inclusion criteria: pediatric patients, aged 3-12 years, undergoing elective MRI under deep sedation.
Key exclusion criteria: history of thoracic surgery and lung disease; respiratory infection; airway abnormality; increased intracranial or intraocular pressure; uncontrolled hypertension; uncontrolled seizure; allergy or contraindications for the study drugs; pulmonary pathology.
Interventions
N=53 propofol/ketamine (0.2 mL/kg of 0.5% propofol and 1 mg/kg ketamine followed by continuous propofol 100 mcg/kg/min and ketamine 20 mcg/kg/min infusion).
N=54 propofol (0.2 mL/kg of 1% propofol and 2 mL of 0.9% saline followed by continuous propofol 200 mcg/kg/min and 0.9% saline 0.04 mL/kg/min infusion).
Primary outcome
Atelectasis assessed by lung ultrasound
58.5%
88.9%
88.9 %
66.7 %
44.5 %
22.2 %
0.0 %
Propofol/ketamine
Propofol
Significant
decrease ▼
NNT = 3
Significant decrease in atelectasis assessed by lung ultrasound (58.5% vs. 88.9%; RR 0.7, 95% CI 0.5 to 0.8).
Secondary outcomes
Significant decrease in median total lung score (2 points vs. 6 points; MD -4, 95% CI -5 to -2).
Significantly shorter median time to emergence (15 minutes vs. 25 minutes; MD -9, 95% CI -12 to -6).
No significant difference in emergence delirium (11.3% vs. 18.5%; RR 0.6, 95% CI 0.2 to 1.6).
Safety outcomes
No significant difference in adverse events during postanesthesia care unit stay.
Significant difference in adverse events within 24 hours after sedation (30% vs. 50%).
Conclusion
In pediatric patients, aged 3-12 years, undergoing elective MRI under deep sedation, propofol/ketamine was superior to propofol with respect to atelectasis assessed by lung ultrasound.
Reference
Yu Jeong Bang, Jeayoun Kim, Nam-Su Gil et al. Pulmonary Atelectasis After Sedation With Propofol vs Propofol-Ketamine for Magnetic Resonance Imaging in Children: A Randomized Clinical Trial. JAMA Netw Open. 2024 Nov 4;7(11):e2433029.
Open reference URL