Success rate compared between sevoflurane insufflation via simple oxygen mask and propofol intravenous infusion in small children undergoing MRI: A randomized controlled trial

Abstract

© 2018, Medical Association of Thailand. All rights reserved. Objective: To compare the success rate between sevoflurane insufflation via simple oxygen mask and propofol intravenous infusion in children aged 1 to 6 years undergoing magnetic resonance imaging [MRI]. Materials and Methods: This randomized controlled trial was conducted in pediatric patients aged 1 to 6 years who were scheduled to undergo MRI scan at the Faculty of Medicine Siriraj Hospital during the October 1,2015 to October 31,2016 study period. Patients were randomized into the sevoflurane insufflation (2% sevoflurane) via simple oxygen mask group or the propofol intravenous infusion (propofol 100 mcg/kg/min) group. The primary outcome was success rate ofMRI scan, defined as scan completed without any pause. Causes of interruption during MRI, including hypotension, bradycardia, hypoventilation, desaturation, and movement, were recorded and analyzed. Secondary outcomes were Pediatric Anesthesia Emergence Delirium [PAED] scale, postoperative nausea and vomiting [PONV], and MRI quality. Results: One hundred and forty-four pediatric patients were included. Sevoflurane insufflation yielded a significantly higher MRI success rate than propofol infusion (69.4% vs. 48.6% respectively; p = 0.011). No significant differences were observed between groups for hypotension, movement, or hypertension. Bradycardia occurred significantly more often in the propofol group than in the sevoflurane group (p = 0.043). Emergence time was significantly shorter in the sevoflurane group than in the propofol group (26.1±16.7 vs. 32.2±17.4 minutes, respectively;p = 0.040). There was no significant difference between groups for PAED scale, PONV, or MRI quality. Conclusion: The present study found a significantly higher MRI success rate in the sevoflurane insufflation group than in the propofol infusion group. Sevoflurane insufflation technique should be considered a safe and effective method of anesthesia for small children undergoing painless imaging procedures.