Two Anesthetic Strategies for Pediatric Magnetic Resonance Imaging: Face-Mask Sevoflurane versus an Intravenous Propofol-Ketamine Regimen in a Randomized Parallel-Group Trial.

OBJECTIVE

To compare recovery time between two complete anesthetic strategies for pediatric magnetic resonance imaging: face-mask sevoflurane maintenance and intravenous ketamine-propofol induction followed by intermittent supplemental propofol boluses.

SUBJECTS AND

METHODS

In this single-center randomized trial, 230 children aged 3 months to 10 years were assigned to propofol-ketamine (Group P) or sevoflurane (Group S). After 19 post-randomization exclusions, 211 participants were analyzed per protocol (Group P, n = 106; Group S, n = 105). The primary outcome was recovery time; secondary outcomes included protocol-specific anesthetic escalation, discharge time, respiratory and hemodynamic events, image quality, and peak Pediatric Anesthesia Emergence Delirium (PAED) score.

RESULTS

Recovery time was shorter in Group P (means, 4.46 vs. 5.31 min; 5% trimmed-mean difference [Group S minus Group P], 1.05 min; 95% CI, 0.17-1.94; p = 0.020). Protocol-specific anesthetic escalation was more frequent in Group P (29.2% vs. 11.4%; risk difference, 17.8 percentage points; 95% CI, 7.0-28.2; p = 0.001), whereas peak PAED scores were lower in Group P (Hodges-Lehmann location-shift estimate, -2; 95% CI, -4 to -1; p < 0.001). No between-group differences were detected in discharge time, image quality, or respiratory and hemodynamic outcomes.

CONCLUSION

Propofol-ketamine was associated with a small, approximately one-minute shorter recovery time and more frequent protocol-specific anesthetic escalation, whereas face-mask sevoflurane was associated with higher peak PAED scores. Because no minimal clinically important differences were prespecified, their clinical and operational importance remains uncertain. Nonsignificant safety findings do not establish equivalent safety.