Clinical Efficacy of Dexmedetomidine and Propofol in Children Undergoing MRI for Urological Diseases: A Systematic Review: Dexmedetomidine and Propofol in Children Undergoing MRI for Urological Diseases

Pakeeza Shafiq; Muhammad Umer Iqbal Butt; Hafiz Wajih Ul Hassan; Saba Maqsood; Syed Imtiaz Ali Zaidi; Aftab Ahmed; Ehsan Ul Haq

doi:10.54393/pjhs.v5i12.2590

Authors

Pakeeza Shafiq Department of Surgery, College of Medicine, Northern Border University, Saudi Arabia
Muhammad Umer Iqbal Butt Department of Anesthesia, Allama Iqbal Medical College/Jinnah Hospital, Lahore, Pakistan
Hafiz Wajih Ul Hassan Department of Anesthesia, Evercare Hospital, Lahore, Pakistan
Saba Maqsood Department of Radiology, Avicenna Medical and Dental College, Lahore, Pakistan
Syed Imtiaz Ali Zaidi Department of Anesthesiology and Intensive Care, Avicenna Medical College and Hospital, Lahore, Pakistan
Aftab Ahmed Department of Urology, Sheikh Khalifa Bin Zaid Hospital/Combined Military Hospital, Muzaffarabad, Pakistan
Ehsan Ul Haq Department of Allied Health Sciences, University of Health Sciences, Lahore, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v5i12.2590

Keywords:

Dexmedetomidine, Propofol, Paediatric Sedation, Magnetic Resonance Imaging

Abstract

Dexmedetomidine and propofol are commonly compared drugs used for sedation during pediatric anesthesia and Magnetic Resonance Imaging. However, their effectiveness and the impact on safety regarding children who undergo magnetic resonance imaging for specific urological diseases such as vesicoureteral reflux, hydronephrosis, and posterior urethral valves remain undetermined. Objectives: To evaluate the quality of sedation, recovery profiles, and complications using dexmedetomidine and propofol in pediatric patients undergoing magnetic resonance imaging for urological indications. Methods: Research with guidance from PRISMA was done in the PubMed, Google Scholar, and Semantic Scholar databases. Peer-reviewed articles that were published between January 2013 and April 2024 were identified bringing into the study 96 articles after applying the inclusion criteria. Cohort review: Fifteen studies were included in the present comparative analysis of dexmedetomidine and propofol for pediatric magnetic resonance imaging sedation. Results: Compared with propofol, dexmedetomidine provided better haemodynamic control, minimized emergence phenomenon and significantly improved postoperative recovery profiles. Nevertheless, the induction and recovery period was shorter in patients who received propofol. Both agents were associated with low adverse events incidences although subjects who received dexmedetomidine reported improved sedation quality that required less rescue medication than other subjects. Conclusions: It was concluded that dexmedetomidine and propofol are good in magnetic resonance imaging sedation for children with urological diseases, with better recovery and improved quality sedation from dexmedetomidine. Future research should extend the duration of intervention and make the dose-response relationship more precise.

References

Paraboschi I, Mantica G, Minoli DG, De Marco EA, Gnech M, Bebi C et al. Fluorescence-Guided Surgery and Novel Innovative Technologies for Improved Visualization in Pediatric Urology. International Journal of Environmental Research and Public Health. 2022 Sep; 19(18): 11194. doi: 10.3390/ijerph191811194. DOI: https://doi.org/10.3390/ijerph191811194

Arnold TC, Freeman CW, Litt B, Stein JM. Low‐Field MRI: Clinical Promise and Challenges. Journal of Magnetic Resonance Imaging. 2023 Jan; 57(1): 25-44. doi: 10.1002/jmri.28408. DOI: https://doi.org/10.1002/jmri.28408

Elsaeidy AS, Ahmad AH, Kohaf NA, Aboutaleb A, Kumar D, Elsaeidy KS et al. Efficacy and Safety of Ketamine-Dexmedetomidine Versus Ketamine-Propofol Combination for Periprocedural Sedation: A Systematic Review and Meta-analysis. Current Pain and Headache Reports. 2024 Apr; 28(4): 211-27. doi: 10.1007/s11916-023-01208-0. DOI: https://doi.org/10.1007/s11916-023-01208-0

Wang XD, Yang B, Fan LL, Guo N, Song HB. Application of Dexmedetomidine combined with Propofol Intravenous Anesthesia in Laparoscopic Day Surgery in Pediatric Urology. Pakistan Journal of Medical Sciences. 2022 Jan; 38(1): 150. doi: 10.12669/pjms.38.1.4378. DOI: https://doi.org/10.12669/pjms.38.1.4378

Freriksen JJ, van der Zanden TM, Holsappel IG, Molenbuur B, de Wildt SN. Best Evidence-Based Dosing Recommendations for Dexmedetomidine for Premedication and Procedural Sedation in Pediatrics: Outcome of A Risk-Benefit Analysis by the Dutch Pediatric Formulary. Pediatric Drugs. 2022 May; 24(3): 247-57. doi: 10.1007/s40272-022-00498-y. DOI: https://doi.org/10.1007/s40272-022-00498-y

McKinstry-Wu A, Jiang T, Mandel A, Ayensu K, Thomas S. for Neuroscience in Anesthesiology and Critical Care, September 8-10, 2023. J Neurosurg Anesthesiol. 2023 Oct; 35(4). doi: 10.1097/ANA.0000000000000935. DOI: https://doi.org/10.1097/ANA.0000000000000935

Bar-Sever Z, Shammas A, Gheisari F, Vali R. Pediatric Nephro-Urology: Overview and Updates in Diuretic Renal Scans and Renal Cortical Scintigraphy. In Seminars in Nuclear Medicine. 2022 Jul; 52(4): 419-431. doi: 10.1053/j.semnuclmed.2021.12.002. DOI: https://doi.org/10.1053/j.semnuclmed.2021.12.002

Wiener JS, Huck N, Blais AS, Rickard M, Lorenzo A, Di Carlo HN et al. Challenges in Pediatric Urologic Practice: A Lifelong View. World Journal of Urology. 2021 Apr; 39: 981-91. doi: 10.1007/s00345-020-03203-1. DOI: https://doi.org/10.1007/s00345-020-03203-1

Zhang W, Wang L, Zhu N, Wu W, Liu H. A Prospective, Randomized, Single-Blinded Study Comparing the Efficacy and Safety of Dexmedetomidine and Propofol for Sedation During Endoscopic Retrograde Cholangiopancreatography. BioMed Central Anesthesiology. 2024 May; 24(1): 191. doi: 10.1186/s12871-024-02572-z. DOI: https://doi.org/10.1186/s12871-024-02572-z

Falkiewicz MK, Su R, Jones SL, Shayan M, Farhat WA, Peters ME. Pediatric Sedation Unit: A Safe, Effective, and Satisfactory Alternative to Outpatient Pediatric Urological Procedures Under Anesthesia. Urology Practice. 2023 Mar; 10(2): 171-6. doi: 10.1097/UPJ.0000000000000364. DOI: https://doi.org/10.1097/UPJ.0000000000000364

Tang S, Liu J, Ding Z, Shan T. The Effect of Dexmedetomidine On Emergence Delirium of Postanesthesia Events in Pediatric Department: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Medicine. 2024 Sep; 103(36): e39337. doi: 10.1097/MD.0000000000039337. DOI: https://doi.org/10.1097/MD.0000000000039337

Johnson KL, Cochran J, Webb S. Lower-Dose Propofol Use for MRI: A Retrospective Review of a Pediatric Sedation Team's Experience. Pediatric Emergency Care. 2021 Nov; 37(11): e700-6. doi: 10.1097/PEC.0000000000002289. DOI: https://doi.org/10.1097/PEC.0000000000002289

Handlogten K, Warner L, Granberg C, Gargollo P, Thalji L, Haile D. Implementation of a Spinal Anesthesia and Sedation Protocol That Reliably Prolongs Infant Spinal Anesthesia: Case Series of 102 Infants Who Received Spinal Anesthesia for Urologic Surgery. Pediatric Anesthesia. 2020 Dec; 30(12): 1355-62. doi: 10.1111/pan.14024. DOI: https://doi.org/10.1111/pan.14024

Zhang X, Bai Y, Shi M, Ming S, Jin X, Xie Y. Effect of Different Administration and Dosage of Dexmedetomidine in the Reduction of Emergence Agitation in Children: A Meta-Analysis of Randomized Controlled Trials with Sequential Trial Analysis. Translational Pediatrics. 2021 Apr; 10(4): 929. doi: 10.21037/tp-21-105. DOI: https://doi.org/10.21037/tp-21-105

Gernhold C, Kundtner N, Steinmair M, Henkel M, Oswald J, Haid B. Sedation Rate Reduction in Paediatric Renal Nuclear Medicine Examinations: Consequences of a Targeted Audit. Children. 2021 May; 8(5): 424. doi: 10.3390/children8050424. DOI: https://doi.org/10.3390/children8050424

Roberts RJ, Banta L, Verghese ST. Non-Operating Room Anesthesia for Pediatric Surgical Procedures. Anesthetic Management in Pediatric General Surgery: Evolving and Current Concepts. 2021: 101-17. doi: 10.1007/978-3-030-72551-8_6. DOI: https://doi.org/10.1007/978-3-030-72551-8_6

Gnech M, van Uitert A, Kennedy U, Skott M, Zachou A, Burgu B et al. European Association of Urology/European Society for Paediatric Urology Guidelines on Paediatric Urology: Summary of the 2024 Updates. European Urology. 2024 Apr. doi: 10.1016/j.eururo.2024.03.025. DOI: https://doi.org/10.1016/j.eururo.2024.03.025

Bang YJ, Kim J, Gil NS, Sim WS, Ahn HJ, Park MH et al. Pulmonary Atelectasis After Sedation with Propofol vs Propofol-Ketamine for Magnetic Resonance Imaging in Children: A Randomized Clinical Trial. Journal of the American Medical Association Network Open. 2024 Nov; 7(11): e2433029-. doi: 10.1001/jamanetworkopen.2024.33029. DOI: https://doi.org/10.1001/jamanetworkopen.2024.33029

Rogers AP. Sedation for Radiological Procedures. Pediatric Sedation Outside of the Operating Room: A Multispecialty International Collaboration. 2021: 475-95. doi: 10.1007/978-3-030-58406-1_23. DOI: https://doi.org/10.1007/978-3-030-58406-1_23

Kerkhofs L, Allegaert K, Toelen J, Vanhonsebrouck K. Pediatric Procedural Sedation and Analgesia (PROSA) in the Leuven University Hospitals: An Audit On Efficacy and Safety. Children. 2022 May; 9(6): 776. doi: 10.3390/children9060776. DOI: https://doi.org/10.3390/children9060776

Moltoni G, Lucignani G, Sgrò S, Guarnera A, Rossi Espagnet MC, Dellepiane F et al. MRI Scan with the “Feed and Wrap” Technique and with an Optimized Anesthesia Protocol: A Retrospective Analysis of a Single-Center Experience. Frontiers in Pediatrics. 2024 Aug; 12: 1415603. doi: 10.3389/fped.2024.1415603. DOI: https://doi.org/10.3389/fped.2024.1415603

Rebollar RE, Palacios MG, Riobó MF, Morera LT. Dexmedetomidine and Perioperative Analgesia in Children. Revista Española de Anestesiología y Reanimación (English Edition). 2022 Oct; 69(8): 487-92. doi: 10.1016/j.redare.2022.08.003. DOI: https://doi.org/10.1016/j.redare.2022.08.003

Nthodi TV, Madathil Abdul BP, Subramonian M, Krishnankutty R. Effect of Dexmedetomidine Versus Propofol on Sevoflurane Related Emergence Agitation in Paediatric Patients: A Randomized Clinical Study. Journal of Clinical and Diagnostic Research. 2024 May; 18(5). doi: 10.7860/JCDR/2024/68717.19374. DOI: https://doi.org/10.7860/JCDR/2024/68717.19374

Ma H, Wachtendorf LJ, Santer P, Schaefer MS, Friedrich S, Nabel S et al. The Effect of Intraoperative Dexmedetomidine Administration On Length of Stay in the Post-Anesthesia Care Unit in Ambulatory Surgery: A Hospital Registry Study. Journal of Clinical Anesthesia. 2021 Sep; 72: 110284. doi: 10.1016/j.jclinane.2021.110284. DOI: https://doi.org/10.1016/j.jclinane.2021.110284

Rahayu NR and Mutripah S. Compared Effectiveness, Safety and Cost of Dexmedetomidine with Midazolam: A Review. Pharmacology, Medical Reports, Orthopedic, and Illness Details. 2023 Jul; 2(2): 85-95. doi: 10.55047/comorbid.v2i2.881. DOI: https://doi.org/10.55047/comorbid.v2i2.881

Negm AN. Efficacy and Safety of Dexmedetomidine Combined with Bupivacaine in Infants’ Surgeries: A Randomized Controlled Trial. Suez Canal University Medical Journal. 2024 Jan; 27(1): 41-52. doi: 10.21608/scumj.2024.342791. DOI: https://doi.org/10.21608/scumj.2024.342791

Kim JY, Kim KN, Kim DW, Lim HJ, Lee BS. Effects of Dexmedetomidine Sedation for Magnetic Resonance Imaging in Children: A Systematic Review and Meta-Analysis. Journal of Anesthesia. 2021 Aug; 35: 525-35. doi: 10.1007/s00540-021-02946-4. DOI: https://doi.org/10.1007/s00540-021-02946-4

Jung SM. Drug Selection for Sedation and General Anesthesia in Children Undergoing Ambulatory Magnetic Resonance Imaging. Yeungnam University Journal of Medicine. 2020 Jul; 37(3): 159-68. doi: 10.12701/yujm.2020.00171. DOI: https://doi.org/10.12701/yujm.2020.00171

Shioji N, Everett T, Suzuki Y, Aoyama K. Pediatric Sedation Using Dexmedetomidine and Remimazolam for Magnetic Resonance Imaging. Journal of Anesthesia. 2022 Feb; 36(1): 1-4. doi: 10.1007/s00540-021-02957-1. DOI: https://doi.org/10.1007/s00540-021-02957-1

Zhao Y, Qin F, Liu Y, Dai Y, Cen X. The Safety of Propofol Versus Sevoflurane for General Anesthesia in Children: A Meta-Analysis of Randomized Controlled Trials. Frontiers in Surgery. 2022 Jun; 9: 924647. doi: 10.3389/fsurg.2022.924647. DOI: https://doi.org/10.3389/fsurg.2022.924647

Saugel B, Bebert EJ, Briesenick L, Hoppe P, Greiwe G, Yang D et al. Mechanisms Contributing to Hypotension After Anesthetic Induction with Sufentanil, Propofol, and Rocuronium: A Prospective Observational Study. Journal of Clinical Monitoring and Computing. 2022 Apr: 1-7. doi: 10.1007/s10877-021-00653-9. DOI: https://doi.org/10.1007/s10877-021-00653-9

Zeigler LN, Modes KB, Deshpande JK. Anesthesia for Pediatric Urological Procedures. Gregory's Pediatric Anesthesia. 2020 Apr: 813-33. doi: 10.1002/9781119371533.ch32. DOI: https://doi.org/10.1002/9781119371533.ch32

Kim HY, Choi YH, Lee SJ. Effect of Sedation Anesthesia with Intravenous Propofol on Transrectal Ultrasound-guided prostate biopsy outcomes. Journal of Korean Medical Science. 2022 Apr; 37(15). 10.3346/jkms.2022.37.e115. DOI: https://doi.org/10.3346/jkms.2022.37.e115

Sager C, Barroso Jr U, Netto MB, Retamal G, Ormaechea E. Management of Neurogenic Bladder Dysfunction in Children Updates and Recommendations On Medical Treatment. International Brazilian Journal of Urology. 2022 Jan; 48: 31-51. doi: 10.1590/s1677-5538.ibju.2020.0989. DOI: https://doi.org/10.1590/s1677-5538.ibju.2020.0989

Sperotto F, Mondardini MC, Dell’Oste C, Vitale F, Ferrario S, Lapi M et al. Efficacy And Safety of Dexmedetomidine for Prolonged Sedation in the PICU: A Prospective Multicenter Study (PROSDEX). Pediatric Critical Care Medicine. 2020 Jul; 21(7): 625-36. doi: 10.1097/PCC.0000000000002350. DOI: https://doi.org/10.1097/PCC.0000000000002350

Jefferson FA, Findlay BL, Handlogten KS, Gargollo PC, Warner LL, Woodbury JM et al. Spinal Anesthesia in Infants Undergoing Urologic Surgery Duration Greater Than 60 Minutes. Journal of Pediatric Urology. 2022 Dec; 18(6): 786-e1. doi: 10.1016/j.jpurol.2022.07.003. DOI: https://doi.org/10.1016/j.jpurol.2022.07.003

Alsaywid BS, Alyami FA, Alqarni N, Neel KF, Almaddah TO, Abdulhaq NM et al. Urinary Tract Infection in Children: A Narrative Review of Clinical Practice Guidelines. Urology Annals. 2023 Apr; 15(2): 113-32. doi: 10.4103/ua.ua_147_22. DOI: https://doi.org/10.4103/ua.ua_147_22

Fattah Kamel AA, Abdel Naby SM, Elmesallamy WA, Salem DA. Opioid Sparing Analgesia: Continuous Intraoperative Infusion of Dexmedetomidine Versus Lidocaine for Intracranial Surgeries in Children: A Double-Blind Randomized Clinical Trial. Egyptian Journal of Anaesthesia. 2022 Dec; 38(1): 158-65. doi: 10.1080/11101849.2022.2048580. DOI: https://doi.org/10.1080/11101849.2022.2048580

Stein R, Bogaert G, Dogan HS, Hoen L, Kocvara R, Nijman RJ et al. EAU/ESPU Guidelines On the Management of Neurogenic Bladder in Children and Adolescent Part I Diagnostics and Conservative Treatment. Neurourology and Urodynamics. 2020 Jan; 39(1): 45-57. doi: 10.1002/nau.24211. DOI: https://doi.org/10.1002/nau.24211

Hayatghaibi SE, Cazaban CG, Chan SS, Dillman JR, Du XL, Huang YT et al. Turnaround Time and Efficiency of Pediatric Outpatient Brain Magnetic Resonance Imaging: A Multi-Institutional Cross-Sectional Study. Pediatric Radiology. 2023 May; 53(6): 1144-52. doi: 10.1007/s00247-022-05563-9. DOI: https://doi.org/10.1007/s00247-022-05563-9

Frush DP, Callahan MJ, Coley BD, Nadel HR, Paul Guillerman R. Comparison of the Different Imaging Modalities Used to Image Pediatric Oncology Patients: A COG Diagnostic Imaging Committee/SPR Oncology Committee White Paper. Pediatric Blood and Cancer. 2023 Jun; 70: e30298. doi: 10.1002/pbc.30298. DOI: https://doi.org/10.1002/pbc.30298