MR-compatible pumps versus manual titration of propofol for pediatric sedation

Abstract

This study aimed to review the use of two methods of propofol infusion: a metred burette system where propofol is diluted in Lactated Ringer using the rule of six [] or an infusion pump: Medrad Continuum Magnetic resonance (MR) compatible Infusion System (Medrad Inc. Indianola, PA) and to determine the difference, if any, between the total amount of drug delivered, the impact on vital signs, sedation status and discharge time of the patients. With Institutional Review Board (IRB) approval, 140 children aged 0 to 18 years, American Society of Anesthesiologists (ASA) physical status I or II requiring sedation for elective outpatient brain Magnetic Resonance Imaging (MRI) examination were included in the study. A total of 70 patients in each group were studied. The (Mean ± S.D.) total amount of propofol infused was significantly less in the infusion pump group (12.47 ± 7.67 mg/kg) than the metred burette system (15.84 ± 16.13 mg/kg, p = 0.003). There were also significant mean differences in awakening times (26.63 ± 16.35 vs. 37.06 ± 20.98 min, p = 0.006), and discharge times (53.46 ± 21.12 vs. 67.89 ± 26.84 min, p = 0.008) in the infusion pump group versus the buretrol infusion group. This study demonstrates that both infusion techniques preserve haemodynamic stability and are associated with minimal complications. The use of an infusion pump, which consistently maintains accurate dosing, reduces the amount of propofol judged adequate by the anaesthesiologist to achieve sedation in MRI. This leads to a more consistently faster emergence and early discharge after sedation in children undergoing MRI studies.

Keywords:

• MR-compatible pump
• Manual titration
• Pediatric
• Sedation

Aknowledgements

The authors acknowledge the contribution of the CNMC MRI nursing team and Dr. Richard Kaplan in the realisation of this study. They also to thank Medrad Inc. for their supportive grant.