Anesthesia (sedation) selecting algorithm ensuring magnetic resonance imaging in children with neurological disorders
Objective. To develop anesthesia (sedation) selecting algorithm in children with neurological disorders undergoing magnetic resonance imaging. Material and methods. We have retrospectively analyzed anesthesia protocols during magnetic resonance imaging without contrast enhancement in patients with neurological pathology. Four methods of anesthesia were studied: inhalation anesthesia with sevoflurane and midazolam intranasal premedication, inhalation anesthesia with sevoflurane and intravenous administration of propofol, monoanesthesia with sevoflurane as a control group; intranasal sedation with dexmedetomidine in neuromuscular pathology. For each patient, parameters of cardiovascular and respiratory systems, patient’s response to induction according to Mask acceptance scale, awakening time according to modified Aldrete scale, incidence and severity of post-anesthetic agitation according to Watcha scale were evaluated. Results. Intranasal sedation with dexmedetomidine ensures magnetic resonance imaging lasting up to 1 hour in children with neuromuscular pathology. Premedication with midazolam reduces the negative reaction to the mask and ensures comfortable induction. Propofol infusion at the end of anesthesia and premedication with midazolam did not significantly decrease the incidence of post-anesthetic agitation. However, severity of agitation was significantly reduced (p <0.01). Conclusion. Intranasal sedation with dexmedetomidine is recommended for neuromuscular pathology. Inhalation anesthesia in combination with intranasal midazolam premedication is recommended if contraindications are absent. In case of negative reaction at induction, intravenous administration of propofol at the end of anesthesia is recommended in order to prevent post-anesthetic agitation.