Pediatric sedation using dexmedetomidine and remimazolam for magnetic resonance imaging

The use of magnetic resonance imaging (MRI) in the pediatric population is expanding.Children usually need general anesthesia or sedation to be still for adequate MRI images.While dexmedetomidine has potential benefit for pediatric MRI sedation because of preservation of airway tone, there is not currently consensus for its use for pediatric MRI sedation.In this issue of Journal of Anesthesia, Kim et al. conducted a systematic review and meta-analysis of randomized controlled trials [1], in which they assessed the efficacy and safety of dexmedetomidine sedation for pediatric MRI compared to propofol, ketamine, and midazolam.The authors showed that compared to propofol, ketamine, and midazolam, dexmedetomidine sedation for pediatric MRI resulted in delayed sedation onset [Weighted mean differences (WMD) = 8.13 min, 95% CI = 4.64-11.63)and recovery times (WMD = 5.22 min, 95% CI = 0.35-10.09)and decreased heart rate (WMD = -17.34beats per minute, 95% CI = -22.42 to -12.26).Of note, dexmedetomidine sedation was associated with a lower incidence of desaturation events (RR = 0.42, 95% CI = 0.20-0.86).There was no difference in sedation quality or incidence of sedation failure.They concluded that dexmedetomidine has the same sedation quality as other drugs but fewer respiratory events.