• Mohammed Alsabri Hussein Alsabri, Abdelrahman Abdelshafi, Bostamy ElsnhoryAhmedAFaculty of Medicine, Al-Azhar university, Cairo, Egypt., Noha Samir Selim, ElsnhoryAlaa BostamyABFaculty of Medicine, Al-Azhar university, Cairo, Egypt., Douaa Albelal, Fatima Akram, and Alaa Ahmed Elshanbary.
• Faculty of Medicine, Assiut University, Asyut, Egypt.
• Pediatr Emerg Care. 2024 Sep 1; 40 (9): e233e239e233-e239.

BackgroundPediatric patients often require sedation during magnetic resonance imaging (MRI) and computed tomography (CT) to ensure stillness and minimize stress. This meta-analysis compared the effectiveness and safety of 3 sedative agents-dexmedetomidine, midazolam, and chloral hydrate-for pediatric MRI/CT sedation.MethodsSix studies with a total of 633 patients were included in the analysis. Quality assessment revealed varying levels of bias risk. Dexmedetomidine exhibited a significantly higher successful sedation rate compared to midazolam (risk ratio [RR] = 0.43, 95% confidence interval [CI] [0.29-0.64]), but no statistically significant difference compared to chloral hydrate (RR = 0.94, 95% CI [0.60-1.45]). Chloral hydrate also showed a higher successful sedation rate compared to midazolam (RR = 0.46, 95% CI [0.25-0.83]). The onset of sedation time did not significantly differ between the 3 agents.ResultsThe dexmedetomidine group had a significantly higher incidence of bradycardia compared to the chloral hydrate group (RR = 0.17, 95% CI [0.05-0.59]), but no significant difference compared to the midazolam group (RR = 0.29, 95% CI [0.06-1.26]). No statistically significant differences were observed in the incidence of nausea and vomiting between the 3 groups.ConclusionsDexmedetomidine demonstrates effectiveness in pediatric MRI/CT sedation, offering advantages over midazolam and similar efficacy to chloral hydrate. Careful cardiovascular monitoring is essential during administration, particularly in patients with congenital heart disease. Sublingual and intranasal administration of dexmedetomidine is a viable option with high bioavailability. This meta-analysis contributes valuable insights into refining sedation protocols for pediatric imaging procedures, emphasizing efficacy and safety considerations.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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