Comparison of procedural sedation using dexmedetomidine and the combination of dexmedetomidine with S-ketamine during magnetic resonance examination of the endocranium in children

Abstract

Introduction/Objective There is an increasing number of children requiring magnetic resonance imaging (MRI) of the brain as a diagnostic procedure. During the scan, it is necessary for the child to remain still for an extended period. This is often challenging due to the patient’s age, as well as the nature of the disease, which often makes them neurologically altered and uncooperative. The aim of this study was to evaluate the quality and safety of procedural sedation in children undergoing MRI of the brain by comparing two different sedation protocols.

Methods The study included 60 participants, aged 1–18 years, who required sedation during MRI of the brain. Using simple randomization, they were divided into two groups: the dexmedetomidine group (DEX group) was sedated with dexmedetomidine, and the dexmedetomidine/S-ketamine (DEX/KES group) received a combination of dexmedetomidine and S-ketamine.

Results Our results showed that the time to achieve adequate sedation was significantly shorter in the DEX/KES group (6.37 ± 3.62 min) compared to the DEX group (9.03 ± 3.48 min) (p = 0.005). During the initial 10 minutes, the average dexmedetomidine dose was identical in both groups (1.59 mcg/kg). However, during the continuous infusion phase until the end of sedation, the average dexmedetomidine dose was 1.47 mcg/kg in the DEX/KES group versus 1.60 mcg/kg in the DEX group. Analysis of hemodynamic parameters showed better stability in the DEX/KES group. Complications occurred more frequently in the DEX group.

Conclusion The dexmedetomidine/S-ketamine group provides a faster onset of sedation, better hemodynamic stability, lower total doses of sedatives, and fewer complications compared to dexmedetomidine alone.

Keywords: procedural sedation; S-ketamine; dexmedetomidine; magnetic resonance imaging