Neonatal Med.  2020 Aug;27(3):105-110. 10.5385/nm.2020.27.3.105.

Sedation for Brain Magnetic Resonance Imaging in Preterm Infants: Using Propofol under Anesthesiologist Supervision

• Han YS
• Kim HH
• Kim HS
• Yang MS
• Ahn SY
• Sung SI
• Chang YS
• Park WS

• KMID: 2505660
• DOI: http://doi.org/10.5385/nm.2020.27.3.105

Abstract

Purpose
We aimed to compare two different sedation protocols for brain magnetic resonance imaging (MRI) in preterm infants. One protocol used chloral hydrate (CH) with monitoring conducted by non-anesthesiologists, and the other used a continuous infusion of propofol (PF) with monitoring by anesthesiologists.
Methods
A total of 250 preterm infants born between January 2011 and December 2015 who received brain MRI during hospitalization in our neonatal intensive care unit (NICU) were included in this retrospective study. In period 1, sedation for brain MRI was done using a single dose or multiple doses of CH with monitoring conducted by NICU medical staff. In period 2, an anesthesiologist prescribed a continuous infu­sion of PF and titrated the dosage for minimal and adequate sedation. Data on the adverse events, including desaturation and bradycardia, were collected and compared between periods 1 and 2.
Results
Despite similar gestational ages of the patients in periods 1 and 2, the infants in period 1 showed a higher risk of developing bradycardia after sedation compared to those in period 2 (30.2% vs. 14.8%; an adjusted odds ratio of 2.35; 95% confidence interval of 1.12 to 4.91). Infants who had an adverse event after sedation had a lower gestational age and corrected age at the time of MRI (26.8 weeks vs. 27.9 weeks, P=0.004; 37.3 weeks vs. 38.3 weeks, P=0.023). The duration of MRI was significantly longer in infants that had an adverse event than those that did not (70.9 minutes vs. 64.3 minutes). After adju­sting for various clinical factors, lower gestational age, lower corrected age at the time of MRI, and period 1 increased the risk of developing adverse events after sedation for MRI.
Conclusion
The use of a continuous PF infusion with dose titration and monitoring by an anesthesiologist is safe and feasible as a sedation protocol for brain MRI in prematurely born infants.

Keyword

Magnetic resonance imaging; Anesthesiologists; Propofol; Infant; premature

Figure

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  Figure 1. Study population. A total of 250 preterm infants born between 2011 to 2015 were included. Abbreviations: MRI, magnetic resonance imaging; SMC, Samsung Medical Center; NICU, neonatal intensive care unit; CH, chloral hydrate; PF, propofol; MIDA, midazolam.

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