Procedural sedation for MRI in children with ADHD. Issue 10 (22nd July 2015)

• Record Type: Journal Article
• Authors: Kitt, Eimear; Friderici, Jennifer; Kleppel, Reva; Canarie, Michael; Cravero, Joseph
• Is Part Of: Paediatric anaesthesia. Volume 25:Issue 10(2015)
• Page Start: 1026
• Page End: 1032
• Publication Date: 2015-07-22
• Subjects: Pediatric anesthesia -- Periodicals; 617.96798
• DOI: 10.1111/pan.12721
• Languages: English
• ISSNs: 1155-5645

Abstract

<abstract abstract-type="main" id="pan12721-abs-0001"> <title>Summary</title> <sec id="pan12721-sec-0001" sec-type="section"> <title>Background</title> <p>Attention‐deficit hyperactivity disorder (ADHD) is the most common neurobehavioral disorder of childhood, affecting 5–8% of children. It has been observed that these children have poor sedation experiences; however, to date there is minimal research on procedural sedation in this population.</p> </sec> <sec id="pan12721-sec-0002" sec-type="section"> <title>Aim</title> <p>To examine whether children with ADHD required larger doses of propofol for magnetic resonance imaging (MRI) sedation.</p> </sec> <sec id="pan12721-sec-0003" sec-type="section"> <title>Methods</title> <p>The hospital's administrative billing database was used to identify all billing codes for MRI brain scans (with and without contrast) in children aged between 5 and 12 years over the preceding 5.5 years. The hospital's electronic medical record database provided baseline demographics. The sedation record was reviewed for propofol dose, psychostimulant use, and prescribed dose. All children received a standard weight‐based dose of midazolam prior to receiving the necessary amount of propofol. Primary outcome was the dose of propofol administered (mg·kg<sup>−1</sup>) to achieve adequate sedation.</p> </sec> <sec id="pan12721-sec-0004" sec-type="section"> <title>Results</title> <p>A total of 258 procedures met the inclusion criteria. The sample was 52% male, 74% White, 7.8% Black, 7.8% Hispanic, 4.3% Asian, and 6.2% other. ADHD was documented for 49 procedures with a prevalence of 18.5%. Patients with ADHD were older, more likely to be male, Hispanic, or to report race as 'Refused/Unknown'. Indications for MRI for patients with ADHD varied significantly, with 'Behavioral' and 'Neurocutaneous' being significantly overrepresented in the ADHD group. The average sedative dose for all patients was 2.8 mg·kg<sup>−1</sup> (95% CI 2.62–2.94). Sedative dose was similar among children with and without ADHD diagnosis.</p> </sec> <sec id="pan12721-sec-0005" sec-type="section"> <title>Conclusions</title> <p>Our study illustrates that children with ADHD do not have higher sedative requirements to achieve a successful brain MRI.</p> </sec> </abstract>