GA2-60
PACU recovery time in low-dose dexmedetomidine as an adjuvant vs sole propofol sedation for children in MRI
Belzer J, Bell M, Nagoshi M, Ross P
Children's Hospital of Los Angeles, Los Angeles, CA, USA
Purpose: Dexmedetomidine as a low-dose adjunct to propofol sedation reduces airway intervention and improves hemodynamics in pediatric patients undergoing Magnetic Resonance Imaging(MRI). As a sole sedative, higher doses of dexmedetomidine may contribute to delayed recovery. It is unknown if its use as an adjunct prolongs post anesthesia care unit (PACU) recovery time. We hypothesized the addition of low-dose dexmedetomidine to propofol for pediatric MRI cases would not extend PACU recovery time relative to propofol-only sedation.
Methods: We conducted a retrospective chart review at Children’s Hospital Los Angeles (CHLA) of all ASA class 1-3 patients (age 1 month to 20 years) sedated for MRI between November 1 and December 31, 2016. The standard of care (non-protocol) for CHLA MRI sedation is: propofol induction (2-3mcg/kg), maintenance on propofol infusion (250-300mcg/kg/min) and boluses titrated to a Ramsay sedation score of 5 or 6 (group P). At the anesthesiologist’s discretion patients may receive a bolus of 0.5 mcg/kg dexmedetomidine at induction and up to one more 0.5mcg/kg bolus at least 60 minutes post induction for cases over two hours (group D+P).
Primary outcome was PACU recovery time. Recovery time is from the first PACU vital check until PACU nurse scored patient ≥9 on the Modified Aldrete Scoring System. Secondary outcomes were total propofol dose [(dose administered:mcg)/(body weight:kg)/(anesthesia time:min)] and airway interventions (number of patients). Recovery time (min) and total administered propofol dose (mcg/kg/min) were compared between groups using the Wilcoxon rank sum test. Airway intervention analyzed by Chi-squared test.
Results: We identified 173 children in P and 129 in D+P. Median dexmedetomidine dose in the D+P cohort was 0.50 mcg/kg (IQR:0.45 - 0.62). Total propofol dose (mcg/kg/min) in P (214.7; IQR:182.3 - 252.9) was higher (p<0.0001) than D+P (147.6; IQR:127.5 - 180.9). No difference seen in recovery time (min) [P: 28(17-39) vs. D+P: 27(18-41); p=0.997]. The number of patients requiring airway support was greater in P compared to D+P (15/173 vs 3/129; p=0.021).
Discussion: Dexmedetomidine as a low-dose adjunct to propofol for pediatric MRI sedation does not prolong post-procedural recovery time and reduces the need for intra-procedural airway support. Lower intra-operative propofol infusion rates likely decrease airway interventions. Total propofol dose is also lower, leading to decreased plasma concentration and more rapid recovery. These findings support the use of low-dose dexmedetomidine as an adjunct to propofol-based procedural sedation in children.
Conclusion: Low-dose dexmedetomidine (0.5 mcg/kg) as an adjuvant to propofol sedation does not prolong PACU recovery time, reduces total propofol dose, and is associated with fewer intra-procedural airway interventions.
1. Wu J, et al. Comparison of propofol and dexmedetomidine techniques in children undergoing magnetic resonance imaging. Paediatr Anaesth. 2014 Aug;24(8):813-8.
Heard C, et al. A comparison of dexmedetomidine-midazolam with propofol for maintenance of anesthesia in children undergoing magnetic resonance imaging. Anesth Analg. 2008 Dec;107(6):1832-9.
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