Sedation medication received and adverse events related to sedation for brain MRI in children with and without developmental disabilities

Background: There are few studies on sedation medication requirements and sedation related adverse events in developmentally disabled children. Objectives: The objectives of our study were to compare sedation medication received and sedation related adverse events for brain magnetic resonance imaging (MRI) between children with and without developmental disabilities. We hypothesized that developmentally disabled children would require increased doses of sedative medications and will have increased frequency of adverse events when compared with normal children. Methods: We conducted a retrospective chart review on children 1-18 years, who required sedation for an elective brain MRI. Children were excluded if they required sedation for diagnostic imaging other than brain MRI, belonged to ASA category >3, or required general anesthesia. Data on developmental status, demographics and details of sedation medications received along with adverse events were collected. Results: About 53.5% (260/486) of the patients were classified as developmentally disabled. Pentobarbital and fentanyl were the two most common medications used for sedation in children with and without developmental disability. There was no difference in the mean dosages of pentobarbital (3.02 mg·kg^-1 vs 3.06 mg·kg^-1; P = 0.2) and fentanyl (1.01 mcg·kg^-1 vs 1.02 mcg·kg^-1; P = 0.81) in the two groups. There was a threefold increased incidence of hypoxia noted in children with developmental disability (11.9% vs 4.9%; P < 0.01). Presence of developmental disability alone was significantly associated with sedation related hypoxia (OR = 3.2, 95% CI: 1.8, 6.94; P < 0.01). Conclusions: Children with developmental disabilities have similar requirements for sedation medications but are three times more likely to experience hypoxia when compared with normal children.