Airway Dimensions in Children with Neurological Disabilities During Dexmedetomidine and Propofol Sedation for Magnetic Resonance Imaging Study.

OBJECTIVE

Children with neurological disabilities are at an increased risk of airway complications during anaesthesia for magnetic resonance imaging (MRI) with spontaneous respiration. The primary objective of this study was to evaluate airway dimensions during propofol and dexmedetomidine sedation for MRI in children with neurological disabilities. The secondary objective was to examine the adverse respiratory and sedation-related events.

METHODS

Seventy-two children aged 1-6 years undergoing MRI were randomly selected to receive sedation with either 2 mg kg-1 h-1 of propofol or 2 μg kg-1 h-1 of dexmedetomidine. The airway dimensions were measured at soft palate, the base of tongue and mid-epiglottis. Adverse airway events were noted, and the quality of sedation was determined based on the need for dose modification, patient movement and repeat imaging requirements.

RESULTS

There was no significant difference in airway dimensions observed between the dexmedetomidine and propofol groups, except for maximum and minimum transverse diameter (15.4±3.4 vs. 13.4±4.7, p=0.04 and 14.6±3.3 vs. 12.4±4.7, p=0.02 respectively) at soft palate and for cross sectional area difference at the base of tongue (14.5±13.9 vs. 20.1±19.3, p=0.03). Airway obstruction (2/36 vs. 3/36), apnoea (0/36 vs. 3/36) and desaturation (0/36 vs 2/36) occurred less frequently with dexmedetomidine. Additional requirement of sedation (6 vs. 3 patients; p=0.48), movement during imaging (9 vs. 5 patients; p=0.37) and poor image quality necessitating re-acquisition (4 vs. 0 patients; p=0.08) were more frequent with propofol.

CONCLUSION

Airway dimensions were similar during dexmedetomidine and propofol sedation, except for the transverse diameters at soft palate, and for cross-sectional area difference at the base of tongue in spontaneously breathing children with neurological disabilities. Airway complications were less frequent and the quality of sedation was better with dexmedetomidine.