Comparison of the Effects of Midazolam-Ketamine or Midazolam-Propofol Combinations on Hemodynamic Stability, Patient Comfort, and Post-anesthesia Recovery in Children Undergoing Sedation for Magnetic Resonance Imaging Procedures

Abstract

Background: Magnetic resonance imaging (MRI) requires complete immobility of the subject during the acquisition of each sequence, which is highly important for image quality. MRI may necessitate sedation, particularly in young children and in some adolescent and adult patients, although the ideal sedation procedure leading to minimal side effects with the highest patient comfort in children undergoing MRI procedures remains controversial. The aim of this study was to compare the effects of midazolam-ketamine and midazolam-propofol combinations on hemodynamic stability, patient comfort, and post-anesthesia recovery in pediatric patients undergoing sedation for MRI and also to determine the ideal sedation procedure with minimal side effects.

Materials and Methods: The retrospective study included 40 pediatric patients aged between 2 and 12 years with normal growth and an American Society of Anesthesiology physical status (ASA-PS) 1-2 who were sedated with a combination of midazolam-ketamin or midazolam-propofol for the MRI procedure. The 40 patients were divided into two groups based on the drug combination used for sedation: (I) midazolam-ketamine (M-K) (n = 20) and (II) midazolam-propofol (M-P) (n = 20). Demographic characteristics, duration of MRI procedure, total duration of procedure, MRI image quality, family satisfaction, peripheral capillary oxygen saturation (SpO2), systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and Ramsay Sedation Score (RSS) scores were compared between the two groups.

Results: No significant difference was detected between the groups with regard to gender, duration of MRI procedure, and total duration of procedure. The MRI scanning quality was very good in 14 (70%) and moderately good in 6 (30%) subjects in the M-K group, whereas the scanning quality was very good in 9 (45%) and moderately good in 11 (55%) subjects in the M-P group. There were significant differences between the two groups at different times in terms of SBP, DBP, and HR values. No complication was observed in any patient and no patient required additional sedation throughout the procedure.

Conclusion: The midazolam-ketamine combination provided better hemodynamic stability than the midazolam-propofol combination, although the two combinations were similar with regard to patient comfort and post-anesthesia recovery.