Abstract

DEXMEDETOMEDINE AND KETAMINE COMBINED SEDATION FOR PAEDIATRIC PATIENTS UNDERGOING MAGNETIC RESONANCE IMAGING- CASE SERIES

Dr. Mangal Ahlawat, Dr. Rishmeet Kaur*, Dr. Simranjeet Singh Sehgal and Dr. Abhishek Kalra

.

Abstract

MRI in children requires immobility to prevent motion artifacts, and also to maintain hemodynamic stability and regular spontaneous respiration. Hence, pediatric procedural sedation in MRI is very crucial, failure of which might indicate the need for general anesthesia. Several sedative agents like propofol, dexmedetomidine, and ketamine were widely used in, these procedures. Propofol when used individually can lead to deep sedation, hypotension, shallower breathing, apnea especially in children. Ketamine can cause hypertension and hypertonicity, and dexmedetomidine can result in bradycardia. With extensive search of literature, we found that combinations of (optimal) drugs can reduce drug dosage and side effects. So, the current study used a combination of dexmedetomidine and ketamine to assess the safety and efficacy of these agents. A case series of five pediatric cases who underwent MRI were assessed in regards to quality of sedation and quality of scan after they were given the combination therapy. Dexmedetomidine's sympathoinhibitory effects were countered by ketamine's cardiostimulatory effects, preserving good cardiovascular stability. All the five cases showed a good to adequate sedation, and analgesia was satisfactory in all the patients. The combination of dexmedetomidine and ketamine was effective and safe for use in the pediatric preprocedural sedation.

Keywords: Pediatric sedation, dexmedetomidine, ketamine, MRI, sedation quality.