Abstract 3038: Deep Sedation Versus General Anesthesia: Safety and Efficacy in Pediatric Patients Undergoing Cardiac Magnetic Resonance
Background: Remaining motionless during cardiac magnetic resonance (CMR) is problematic in pediatrics yet important for image quality and ventricular mass/volume calculation. Recently, there has been a shift away from deep sedation (DS) in pediatric pts undergoing CMR towards general anesthesia (GA) citing safety concerns, which could make a non-invasive test more invasive.
Purpose/Methods: To determine the safety and efficacy of DS and GA in pediatric pts undergoing CMR, a retrospective review of all cases at our institution from 1997–2006 was undertaken.
Results: Of 821 pts undergoing CMR, 660 (ages 4.3 ± 4.3 years) underwent DS and 161 underwent GA (ages 3.7 ± 4.8 years). Diagnoses included a broad spectrum of congenital heart disease such as single ventricle, transposition of the great arteries and tetralogy of Fallot. There were no serious adverse events including mortalities, hospitalizations or emergency room visits because of DS. There were 18 (2.8%) self-limited events including 12 (1.9%) “paradoxical” reactions and 6 pts (0.8%) who vomited. DS success rate was 97.9%. The adverse event rate for pts undergoing GA was 3.9% (N=6) including 2 overnight hospital stays. Observers blinded to the pt’s sedation status found no difference between images obtained with DS, GA or no sedation. With free breathing and signal averaging, even in young infants, excellent image quality can be obtained (see example).
Conclusions: DS of appropriately screened pediatric pts undergoing CMR is safe, well tolerated and yields high quality images. GA should be considered for pts undergoing CMR with hemodynamic or airway compromise, who have failed DS or have other special circumstances.