Comparison of Dexmedetomidine Administration Strategy for Propofol‐Based Pediatric Sedation for Magnetic Resonance Imaging: A Retrospective Study

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BACKGROUND: Intravenous dexmedetomidine is a safe and effective adjunct in propofol-based sedation. Dexmedetomidine is typically administered as a loading dose, followed by continuous infusion or not. Whether the addition of a maintenance infusion of dexmedetomidine after a loading dose in propofol-based sedation for pediatric magnetic resonance imaging (MRI) can be beneficial in terms of propofol consumption or adverse events is not clear. AIMS: We aimed to study whether maintaining dexmedetomidine infusion after loading dose can help reduce propofol consumption and minimize airway and cardiovascular interventions during sedation. METHODS: We retrospectively reviewed 884 medical records of pediatric sedation for MRI using both propofol and dexmedetomidine, performed at a single tertiary hospital between May 2021 and January 2023. We compared patients who received dexmedetomidine loading + maintenance (group LM) and dexmedetomidine loading only (group L) as an adjunct to propofol-based sedation. The consumption of propofol and time to recovery were measured. We also compared the incidence of airway rescue maneuver and hypotension requiring intervention during sedation. RESULTS: , p = 0.001). The incidence of airway rescue maneuver did not differ significantly between the two groups (0.9 vs. 1.5%, p = 0.501); however, the incidence of hypotension requiring intervention was lower in group LM than in group L (4.3 vs. 8.1%, p = 0.040). The recovery time did not differ significantly between the two groups (34 vs. 34 min, p = 0.932). CONCLUSION: In propofol-based sedation for pediatric MRI, maintenance infusion of dexmedetomidine after a loading dose reduces total propofol consumption and hemodynamic instability requiring intervention without prolonging recovery time, compared with dexmedetomidine bolus without maintenance.

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