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Succesvolle en veilige sedatie voor MRI-onderzoek bij kinderen

De dagelijkse praktijk in Nederland getoetst aan de resultaten van een systematic review van de literatuur

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Tijdschrift voor Kindergeneeskunde

Samenvatting

Tijdens magnetisch resonantie-onderzoek (MRI) hebben jonge kinderen en kinderen met een vertraagde ontwikkeling een vorm van procedurele sedatie (PS) nodig om voldoende (lang) bewegingloos te kunnen blijven liggen. In Nederland hebben zich in het afgelopen decennium ernstige ongevallen voorgedaan tijdens PS voor MRI. Het is aangetoond dat essentiële veiligheidsrichtlijnen ten aanzien van PS onvoldoende geïmplementeerd zijn in de Nederlandse algemene kindergeneeskundige praktijk. Tevens bestaan er zorgen over de matige effectiviteit van vaak toegepaste PS-protocollen. Door middel van een enqueˆte onderzochten we welke PS-technieken en -medicijnen algemeen kinderartsen meestal gebruiken voor MRI bij kinderen. De gemiddelde praktijk werd vergeleken met de resultaten van een systematische review (SR) van de recente literatuur. Door middel van de SR proberen we de klinische vraag te beantwoorden wat op de kinderleeftijd de veiligste en meest effectieve techniek is voor PS tijdens MRI. Nederlandse kinderartsen doen voor MRI zelden beroep op anesthesie. Meestal wordt gebruikgemaakt van een PS op basis van chloralhydraat, midazolam en/of lytische cocktails. Deze sedativa hebben een suboptimale effectiviteit. Het is onbekend hoeveel onderzoeken hierdoor geheel of gedeeltelijk mislukken. Deze medicijnen hebben wel een reëel risico op ernstige complicaties. Het gebruik moet daarom steeds gepaard gaan met verregaande voorzorgsmaatregelen en de aanwezigheid van competente professionals. Van alle sedativa heeft propofol de hoogste effectiviteit. Propofol kan veilig worden gebruikt door competente nietanesthesiologen. Indien deze professionals niet beschikbaar zijn, verdient het aanbeveling om kinderen die gesedeerd moeten worden voor MRI, door te verwijzen naar een anesthesioloog.

Summary

Young children and children with mental impairment that have to undergo magnetic resonance imaging (MRI) will require procedural sedation (PS) to maintain the necessary immobility. In the last decade severe accidents have occurred in the Netherlands in children during PS for MRI. It has been shown that well-established guidelines on PS-related safety are insufficiently implemented in Dutch general paediatrics. In addition, major concerns exist regarding the limited effectiveness of standard PS practices. By the use of a questionnaire we surveyed the PS techniques that Dutch general pediatricians routinely apply for PS in MR. Findings were compared with the results of a systematic review (SR) of the recent literature. By the SR we aim to answer the clinical question: what is the safest and most effective technique of providing PS to children undergoing MRI?

Dutch general pediatricians rarely make use of general anaesthesia for MRI in their patients. The majority applies a PS technique that is based on chloral hydrate, midazolam and/or lytic cocktails. The effectiveness of these sedatives is generally suboptimal, causing an undefined number of total or partial procedural failures. In addition, these drugs may cause severe adverse events, making extensive safety precautions and specific professional competences imperative. Of all studied sedatives the anaesthetic propofol has the highest level of effectiveness. There is good evidence that well-trained non-anaesthesiologists may provide propofol sedation safely. In the absence of these professionals, children in need for sedation for MRI should be referred to an anaesthesiologist.

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Authors and Affiliations

  1. Afdeling Kindergeneeskunde, Maastricht Universitair Medisch Centrum, 5800, 6202, AZ Maastricht, Netherlands

    Piet L.J.M. Leroy

  2. Afdeling Radiologie, VU medisch centrum, Amsterdam, Netherlands

    Jonathan I. M. L. Verbeke

  3. Afdeling Klinische Epidemiologie en Medical Technology Assessment (KEMTA), Maastricht Universitair Medisch Centrum, Maastricht, Netherlands

    Fred H. M. Nieman

  4. St. Antonius Ziekenhuis, Nieuwegein, en Sectie Algemene Pediatrie, Nederlandse Vereniging voor Kindergeneeskunde, Utrecht, Netherlands

    Heleen H. E. A. Blokland-Loggers

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  1. Piet L.J.M. Leroy
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  2. Jonathan I. M. L. Verbeke
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  3. Fred H. M. Nieman
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  4. Heleen H. E. A. Blokland-Loggers
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Correspondence to Piet L.J.M. Leroy.

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Leroy, P.L., Verbeke, J.I.M.L., Nieman, F.H.M. et al. Succesvolle en veilige sedatie voor MRI-onderzoek bij kinderen. TIJDSCHR. KINDERGENEESKUNDE 79, 42–54 (2011). https://doi.org/10.1007/s12456-011-0008-9

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