Comparison of Ketamine-Dexmedetomidine and Ketamine-Propofol for Sedation of Pediatric Patients for MRI and CT scans

Open Access

Abstract

Background: Children often need sedation for MRI/CT to prevent motion artifacts and repeat scans. Ketamine- propofol may allow quicker onset and recovery but can cause hypotension or respiratory events, while ketamine- dexmedetomidine may provide steadier sedation with slower onset and longer recovery. This study aimed to compare KD versus KP for sedation success, image quality, safety, and recovery time in pediatric MRI/CT. Methods & Materials: This comparative study at Gazi Medical College, Khulna, from January to December 2019, enrolled 70 children undergoing MRI/CT sedation, allocated 1:1 to ketamine-dexmedetomidine (n=35) or ketamine-propofol (n=35). IV agents were titrated for immobility with rescue boluses allowed, standard monitoring was used, and outcomes assessed sedation success and timing, image quality and motion, adverse events and airway interventions, plus recovery and 24-hour events, with analyses in SPSS v26 (p<0.05). Results: Baseline characteristics were similar between KD and KP (N=70), and scan completion was high (98.6%). KP achieved faster sedation onset than KD (7.5 ± 2.4 vs 10.1 ± 2.8 min, p<0.001) and shorter recovery, time to arousable (11.6 ± 4.4 vs 18.2 ± 8.8 min, p<0.001) and discharge readiness (38.3 ± 16.7 vs 57.3 ± 17.3 min, p<0.001). Image quality was mostly excellent (68.6%) with few motion repeats (10%), adverse events and airway interventions were similar (51.4% each; 18.6%), while KP had a larger MAP reduction (p=0.007). Conclusion: Both KD and KP provided effective, generally safe sedation for pediatric MRI/CT with high scan completion and similar image quality; however, KP achieved faster sedation onset and significantly shorter recovery and discharge times, while KP showed a greater reduction in mean arterial pressure.