Combining propofol with ketamine for pediatric MRI sedation reduced the incidence of lung atelectasis from 88.9% to 58.5%, according to a recent clinical trial.

The randomized clinical trial evaluated pulmonary atelectasis incidence in children sedated with propofol versus a propofol-ketamine combination during magnetic resonance imaging (MRI). Among 107 pediatric patients (median age, 5 years) undergoing elective MRI, the propofol-ketamine combination significantly reduced atelectasis, as measured by lung ultrasonography, compared to propofol alone.

Published in JAMA Network Open, in the propofol group, atelectasis occurred in 88.9% of patients, while the propofol-ketamine group had a 58.5% incidence. The propofol-ketamine group also demonstrated a faster emergence time (15 vs. 25 minutes; median difference, 9 minutes), and higher nurse and parent satisfaction scores post-procedure. Rates of hypotension were significantly greater in the propofol group (70.4% vs. 45.3%) though hypertension was transiently more common with propofol-ketamine (9.3% vs. 34.0%). Desaturation events and airway interventions did not differ significantly between groups.

Post-discharge, patients in the propofol group exhibited more respiratory complications, including fever, cough, and sputum production, compared to those in the propofol-ketamine group. Most of these events were self-limited.

The propofol-ketamine combination was associated with reduced atelectasis and faster recovery times in MRI sedation. Additional research is warranted to explore the long-term implications of reduced sedation-induced atelectasis. The study’s findings may have limited generalizability, as it was conducted on a cohort of Korean children aged 3 to 12, and results may vary in broader or different pediatric populations.

Full disclosures can be found in the published trial.