Create An Account
Login Create An Account
The Medical Education Network
In Brief | Anaesthetics, Paediatrics & Neonatology
 

New study investigates the incidence of pulmonary atelectasis after MRI sedation with propofol vs propofol-ketamine


Time to read: 02:01
Time to listen: 05:29

 
Published on MedED:  11 November 2024
Originally Published: 1 November 2024
Sourced: JAMA Network Open
Type of article: In Brief
MedED Catalogue Reference: MPIB018
Category: Anaesthesiology
Cross Reference: Paediatrics & Neonatology, Radiology
Keywords: MRI, radiology, sedation, anaesthesia, atelectasis

 

Key Takeaway
In paediatric patients undergoing deep sedation for MRI, a propofol-ketamine combination significantly reduced post-sedation atelectasis, allowing a faster emergence time when compared with propofol alone.
Top

Originally published in JAMA Network Open,1 November 2024. This summary does not represent the original research, nor is it intended to replace the original research. Access the full Disclaimer Information
 
 

As MRI use in paediatric patients increases, so does the demand for effective sedation to ensure immobility during procedures. Yet the effects of anaesthetic agents on pulmonary function during prolonged sedation remain poorly understood.
 
Propofol is commonly used for paediatric MRI sedation due to its rapid onset and recovery; however, it can cause dose-dependent upper airway collapse, with pulmonary atelectasis occurring in approximately 80% of cases. Ketamine, in contrast, helps maintain airway tone and supports spontaneous breathing.
 
While single sedatives are generally considered safer, combining agents like propofol and ketamine may reduce the required doses and minimize side effects. 
 
This single-centre, double-masked, randomized clinical trial study aimed to evaluate whether the propofol-ketamine combination could lower the incidence of atelectasis compared to propofol alone and assess sedation quality and recovery outcomes.
 
The study, conducted at Samsung Medical Center in Seoul, Korea, included children aged 3 to 12 years with an American Society of Anesthesiologists physical status I or II, undergoing elective 3T MRI requiring deep sedation. Exclusion criteria encompassed a history of thoracic surgery, lung disease, respiratory infections, and conditions such as uncontrolled hypertension or seizure disorders.
 
The primary outcome was the incidence of lung atelectasis, assessed by lung ultrasonography upon arrival at the post-anaesthesia care unit (PACU).

Secondary outcomes included total lung score, diaphragm excursion, muscle thickness, sedation induction dose, image quality, adverse events, recovery profiles, nurse satisfaction, and parent-reported outcomes.
 
The protocol for sedation was as follows: 
  • In the propofol group, 0.2 mL/kg of 1% propofol and 2 mL saline (placebo) were administered, followed by continuous infusion of propofol and saline.
  • In the propofol-ketamine group, 0.2 mL/kg of 0.5% propofol and 1 mg/kg of ketamine were administered, followed by continuous infusion of both agents.

The following findings were recorded:
 
107 patients were enrolled and randomly assigned to receive either propofol-only (54) or propofol-ketamine (53).
 
The median age was 5 years [IQR 4-6) and 57.9% were male.
 
Atelectasis occurred in 89% of the propofol group and 58.5% of the propofol-ketamine group (relative risk 0.7; 95% CI 0.5-0.8; P < .001)
 
The total lung score was significantly higher in the propofol-ketamine group (median two vs 6; P < .001), indicating better pulmonary aeration with the combination

Hypertension was more frequent in the propofol-ketamine group (34.0% vs 9.3%; P = .002), while hypotension was more common in the propofol-only group (70.4% vs 45.3%; P = .009)
 
Hypotension was more prolonged in the propofol group (median 25 minutes vs 12 minutes; P = .002). One patient in the propofol group required medication for severe hypotension, experiencing a 60% drop in baseline blood pressure.
 
Desaturation rates, MRI interruptions, and image quality were similar between the two groups
 
Patients in the propofol-ketamine group had faster emergence in the PACU and higher satisfaction from nurses and parents
 
Post-discharge respiratory complications such as fever and cough were more common in the propofol group

One patient in the propofol-ketamine group experienced disorientation, which resolved spontaneously within 6 hours

Complications like dizziness and drowsiness occurred similarly in both groups
 
While further studies are needed to assess the clinical significance of reducing sedation-induced atelectasis, the researchers concluded that the propofol-ketamine combination significantly reduced post-sedation atelectasis and allowed for faster emergence compared to propofol alone in paediatric patients undergoing deep sedation for MRI.

 
Access the original research article. Back to top

Disclaimer
This article is reproduced under the terms of CC-BY-Licence. It is in no way presented as an original work.  Every effort has been made to attribute quotes and content correctly. Where possible, all information has been independently verified. The Medical Education Network bears no responsibility for any inaccuracies which may occur from the use of third-party sources. If you have any queries regarding this article contact us 

Fact-checking Policy
The Medical Education Network makes every effort to review and fact-check the articles used as source material in our summaries and original material. We have strict guidelines in relation to the publications we use as our source data, favouring peer-reviewed research wherever possible. Every effort is made to ensure that the information contained here is an accurate reflection of the original material. Should you find inaccuracies, out of date content or have any additional issues with our articles, please  contact us 

 
Rating  

Most Viewed Articles

8 Healthcare Trends Set to Shape The South African Healthcare Landscape
Dec 13, 2024
The HPCSA has Updated its Accreditation Guidelines: Stay Informed on the New Requirements
Feb 12, 2025
Ethical, Legal and Practical Considerations When Integrating WhatsAPP into Your Clinical Practice
Nov 12, 2024
Rapid SSL

The Medical Education Network
Powered by eLecture, a VisualLive Solution