3 MRI Factors to Control Anesthesia Use with Kids

July 11, 2020

Paying attention to scanner strength, IV contrast, and body parts imaged can contribute to reducing anesthesia use.

“Image Gently” is a familiar standard when it comes to controlling the parameters around imaging children. A group of pediatric radiologists are taking the concept a step further by looking at several aspects of MRI imaging that can play a role in limiting the use of anesthesia during diagnostic scans.

In an effort to identify any relationship between MRI scan time and total propofol dose, a team of investigators from Massachusetts General and Boston Children’s Hospitals examined approximately 500 images from children under age 18. The ultimate goal was to determine whether they could limit the use of anesthetics in kids and potentially determine a range of propofol doses that could be used in clinical practice.

Published on July 8 in the American Journal of Roentgenology, the team pinpointed three possible factors that could predict propofol exposure: 1.5T field strength, IV contrast administration, and the imaging of multiple body parts.

“Pediatric MRI anesthetic exposure can be quantified and predicted based on imaging and clinical variables,” said the team led by Michael S. Gee, M.D., Ph.D., chief of pediatric radiology at Massachusetts General. “We belive the results presented in this study serve as a valuable baseline for future efforts to reduce pediatric MRI anesthetic medication doses and MRI scan times.”

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To identify those three factors, Gee’s team retrospectively examined the electronic health records of pediatric patients to capture all MRI exams conducted between 2016 and 2019. All total, they examined 501 exams from 426 patients, including images of the brain, brain and spine, brain and abdomen, and the brain/head/neck.

Based on their analysis, they found patients who had single body parts examined had shorter MRI scans with less propofol than did patients who were having multiple body parts imaged. But, there were several factors that lengthened scan time and increased anesthesia use for patients having single studies: a higher American Society of Anesthesiologists classification, oncologic diagnosis, 1.5T magnet strength, and IV contrast administration.

MRI is already considered a more preferable option than CT for imaging children due to the lack of ionized radiation. Ultimately, knowing how the scan parameters can affect anesthesia use can valuable, particularly with the youngest patients, they said.

“In children under 6 years of age, MRI often requires general anesthesia that may have long-term detrimental effects,” they wrote. “This study helps identify considerations for minimizing MRI anesthesia use. Higher field strength scanners, unenhanced technique, and single body part imaging will all likely reduce patient anesthesia dose.”