The need for anesthesia for pediatric MRI procedures depends greatly on the age and character of the pediatric patients involved. At our community hospital, we don’t have a dedicated anesthetist at our disposal for difficult imaging cases. The anesthetist would need to be booked in advance of the test scheduled. The realm of sedation required may extend from full IV general anesthetic (propofol, penobarbitol, methohexital) to rectally-introduced sedation, to face mask or simply oral meds 2 hours prior to the exam (i.e. chloral hydrate). In our case, we’re lucky to be close to a world-class pediatric health institution in The Hospital for Sick Children in downtown Toronto, who are very agreeable to taking on more challenging pediatric imaging cases. As such, we rarely have need for anesthetist-monitored pediatric sedation during MRI procedures. We typically suggest oral chloral hydrate in advance of the study for those kids whom parents or referring pediatricians feel can handle the test without IV or rectal-administered sedation. We have recently had children as young as 3 and 4 years old undergo MRI without any sedation at all, with excellent results.

The other main consideration is the body part to be imaged. It’s much more likely that problems with claustrophobia, patient irritation and excess motion will be encountered with head exams vs peripheral extremity exams, due to the intimidating physical structure of the MRI magnet.

I’d suggest that prior to requesting any MRI exams in your community for your pediatric patients, you should call your local radiologists and discuss the need for potential sedation and whether they can handle such a case, if required.

References:

1. Larsen R et al. Clinical Pediatrics 2009;48: 819-23.
2. Bordes M et al. Annales Françaises d’Anesthésie et de Réanimation 2007; 26:287-91.
3. Morris JM, Miller GM. Am J Neuroradiol 2007;28:1964-7.
4. Dala PG et al. Anesth Analg 2006;103:863-8.
5. Usher AG, et al. Paediatric Anaesthesia 2005:15:23-8.
6. Amundsen L et al. Journal of Neurosurgical Anesthesiology 2005;17:180-92.
7. Frigon C et al. Am J Roentgenol 2002;179:791-6.
8. Sedik H. Arch Pediatr Adolesc Med 2001;155:665-8.

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