Role of Low-dose Intramuscular Ketamine in Vascular Access in Pediatric Patients with Sedation Anesthesia in Magnetic Resonance Imaging

Abstract

Objective: While there are few studies on the use of ketamine for sedation during magnetic resonance imaging (MRI) of pediatric patients, we aimed to investigate the effects of low-dose ketamine administered intramuscularly for vascular access on hemodynamics, sedation and recovery, and MRI quality for the first time. Method: A total of 193 pediatric patients aged 3 months to 15 years who received sedation anesthesia for MRI were included in this study. Ninety-nine subjects in the group (Group K) administered ketamine 2.5 mg/kg and below intramuscularly and the propofol-control group (Group C), where 94 subjects were not administered intramuscular ketamine, were divided into two groups. The groups were compared in terms of demographic data, sedation and procedure times, anesthetic drug doses, Ramsay sedation score, hemodynamic parameters, recovery time, modified Aldrete recovery scores, MRI quality, and side effects. Results: The mean values of first dose and additional dose propofol mg/kg in Group K were 0.56 (0.45/0.71) - 0 (0/0), respectively, whereas in Group C the values were 1.11 (0.87/1.33) - 0.14 (0/0.5), respectively. In Group K, the mean systolic arterial pressures, diastolic arterial pressures, and median values of mean arterial pressures during the procedure were found to be higher than those of Group C (p<0.001; =0.001; <0.001, respectively). While the jaw-thrust maneuver was performed in two patients in Group K, airway was required in one patient in Group C. The relationship between the groups in terms of MRI quality was found to be statistically significant (p<0.016). Conclusion: It has been observed that low-dose intramuscular ketamine (2.5 mg/kg and less) used in vascular access provides a positive efficacy and safety profile with less sedative additional drugs, even in agitated children during sedation anesthesia during pediatric MRI, and better MRI quality is achieved.

Keywords

• intramuscular ketamine
• magnetic resonance imaging
• pediatrics
• propofol
• sedation