Swedish techniques for paediatric MRI
Above: Stockholm
A few years ago, an audit I carried out at a UK children’s hospital revealed the waiting list
for outpatient paediatric MRI scans to be a staggering 14 months, owing in part to the time consuming
nature of carrying out general anaesthesia in the MRI suite. The waiting list was so
long that one child had even died whilst waiting for their scan. Since then I have been searching
for different techniques that could increase patient throughput on paediatric MRI lists.
Last year I began working in Scandinavia, and recently a group
of anaesthetists from my hospital travelled to the Karolinska
University Hospital in Stockholm to learn about their sedation
technique that avoids general anaesthesia, which they use for a
large proportion of lower-risk paediatric MRI scans.
A surprising feature is that this is a paediatric nurse-led service with no anaesthetic staff present
Upon arrival at the hospital on the day of the scan, children
who have fulfilled the suitability criteria (Box 1) receive
dexmedetomidine 4 μg.kg
-1 intranasally approximately 30-45 min
before the scan. Those who do not sleep within 30 min receive an
additional dose, either a further 4 μg.kg
-1 or a 2 μg.kg-1 half dose.
In the rare case that a second dose is not enough, the child is
rescheduled for MRI with general anaesthesia on another day.
During the scan itself, monitoring consists of respiratory rate, SaO2
and a camera view of the patient within the scanner core. This
saves time by avoiding intravenous access, multiple drugs, and
the fuss of using breathing circuits, other anaesthetic equipment
and monitoring inside the scanner. A relative is allowed to be
with the child throughout the whole process, including inside the
scanning room. After the scan is complete, the child is placed in
a cot or their own buggy, and are allowed home when rousable
with normal vital signs.
COVID-19 has made waiting lists longer in every hospital department, and we all need to be concentrating on finding new ways to improve efficiency.
Interestingly with this technique, children are allowed to eat and
drink until they leave home. In fact, the team stressed that the
success of the technique was reliant on the children not being
hungry. Obviously the idea of non-fasting children receiving
sedation will ring warning bells for many anaesthetists, but this
method has been used in Sweden for the last four years on
thousands of patients without major adverse incident.
A surprising feature is that this is a paediatric nurse-led service
with no anaesthetic staff present, although there are usually
anaesthetists providing general anaesthesia in neighbouring MRI
suites who could assist in an emergency.
COVID-19 has made waiting lists longer in every hospital
department, and we all need to be concentrating on finding new
ways to improve efficiency. The Karolinska sedation method frees
up anaesthetic staff and is a time saving, simpler alternative to
general anaesthesia.
If you think your department could benefit from setting up a
similar service, I highly recommend visiting Sweden to see for
yourself the exact technique, timings and patient flow during the
list. Additionally, it’s a great excuse to use some study leave to
visit the beautiful city of Stockholm.
William Packer
Anaesthesia Consultant
Tønsberg Hospital, Norway