Original Investigation
Anesthesiology
November 1, 2024
Pulmonary Atelectasis After Sedation With Propofol vs Propofol-Ketamine for Magnetic Resonance Imaging in Children: A Randomized Clinical Trial
Yu Jeong Bang, Jeayoun Kim, Nam-Su Gil, et al
JAMA Netw Open. 2024;7(11):e2433029. doi:10.1001/jamanetworkopen.2024.33029
Question What is the incidence of atelectasis among children sedated for magnetic resonance imaging with propofol vs propofol-ketamine?
Findings In this randomized clinical trial of 107 pediatric patients, the incidence of pulmonary atelectasis and the total lung score, which was evaluated by lung ultrasonography, were significantly lower in the propofol-ketamine sedation group compared with the propofol sedation group.
Meaning In pediatric patients undergoing magnetic resonance imaging under deep sedation, the propofol-ketamine combination reduced the frequency and severity of sedation-induced atelectasis while maintaining effective sedation and allowing a faster emergence time.
Abstract
Importance Little is known about the impact of different anesthetic agents used for routine magnetic resonance imaging (MRI) sedation on pulmonary function in children.
Objective To compare the incidence of pulmonary atelectasis after MRI sedation with propofol vs propofol-ketamine.
Design, Setting, and Participants This double-masked randomized clinical trial screened 117 consecutive pediatric patients aged 3 to 12 years with American Society of Anesthesiologists physical status I to II undergoing elective MRI under deep sedation from November 2, 2022, to April 28, 2023, at a tertiary referral center. Four patients met the exclusion criteria, and 5 patients refused to participate. The participants and outcome assessors were masked to the group allocation.
Interventions During the MRI, the propofol group received 0.2 mL/kg of 1% propofol and 2 mL of 0.9% saline followed by a continuous infusion of propofol (200 μg/kg/min) and 0.9% saline (0.04 mL/kg/min). The propofol-ketamine group received 0.2 mL/kg of 0.5% propofol and 1 mg/kg of ketamine followed by a continuous infusion of propofol (100 μg/kg/min) and ketamine (20 μg/kg/min).
Main Outcome and Measure The incidence of atelectasis assessed by lung ultrasonography examination.
Results A total of 107 children (median [IQR] age, 5 [4-6] years; 62 male [57.9%]), with 54 in the propofol group and 53 in the propofol-ketamine group, were analyzed in this study. Notably, 48 (88.9%) and 31 (58.5%) patients had atelectasis in the propofol and propofol-ketamine groups, respectively (relative risk, 0.7; 95% CI, 0.5-0.8; P < .001). The incidence of desaturation and interruption of the MRI due to airway intervention or spontaneous movement did not significantly differ between the groups. The propofol-ketamine group showed a faster emergence time than the propofol group (15 [9-23] vs 25 [22-27] minutes in the propofol-ketamine vs propofol group; median difference in time, 9.0 minutes; 95% CI, 6.0-12.0 minutes; P < .001). No patient was withdrawn from the trial due to adverse effects.
Conclusions and Relevance In this randomized clinical trial, the propofol-ketamine combination reduced sedation-induced atelectasis while allowing for faster emergence compared with propofol alone.
Trial Registration cris.nih.go.kr Identifier: KCT0007699
