Hypotensive Events in Pediatric Patients Receiving Dexmedetomidine for MRI

Stephanie A Cruz; Anoop Mayampurath; Susan C Vonderheid; Jaimee Holbrook; Nicole L Bohr; Katelyn DeAlmeida; Cynthia M LaFond

doi:10.1016/j.jopan.2023.10.006

Hypotensive Events in Pediatric Patients Receiving Dexmedetomidine for MRI

J Perianesth Nurs. 2023 Nov 22:S1089-9472(23)00993-0. doi: 10.1016/j.jopan.2023.10.006. Online ahead of print.

Authors

Stephanie A Cruz¹, Anoop Mayampurath², Susan C Vonderheid³, Jaimee Holbrook², Nicole L Bohr⁴, Katelyn DeAlmeida⁵, Cynthia M LaFond⁶

Affiliations

¹ Department of Pediatric Sedation, UChicago Medicine Comer Children's Hospital, Chicago, IL.
² Department of Pediatrics, University of Chicago, Chicago, IL.
³ Department of Human Development Nursing Science, University of Illinois Chicago, Chicago, IL.
⁴ Department of Nursing Research, UChicago Medicine, Maryland, IL; Department of Surgery, University of Chicago, Chicago, IL.
⁵ Department of Nursing Research, UChicago Medicine, Maryland, IL.
⁶ Department of Nursing Research, UChicago Medicine, Maryland, IL; Department of Nursing Research, Ascension Health, St. Louis, MO. Electronic address: cynthia.lafond@ascension.org.

PMID: 37999685
DOI: 10.1016/j.jopan.2023.10.006

Abstract

Purpose: Dexmedetomidine, the preferred pediatric sedating agent for magnetic resonance imaging (MRI), has the side effect of hypotension. Newer recommendations for reporting adverse events in pediatric procedural sedation include using a two-pronged definition. Our aim was to describe the incidence of hypotension in patients undergoing sedated MRI and to identify demographic and clinical factors associated with hypotension, applying a two-pronged definition, where a numerical threshold/clinical criterion must be met as well as at least one clinical intervention performed.

Design: An observational cohort study.

Methods: Medical record data were extracted for outpatients less than 18 years of age sedated primarily with dexmedetomidine for MRI in a single center for over a seven-year period. Patients who received propofol as an adjunct were also included. Hypotension was defined using a two-pronged approach, as a 20% reduction in systolic blood pressure from baseline lasting ≥10 minutes, coupled with a fluid bolus. Analysis included descriptive statistics, t tests and logistic regression using discrete-time survival analysis.

Findings: Of the 1,590 patient encounters, 90 (5.7%) experienced hypotension. Males were significantly more likely to have hypotension. Patients with hypotension had overall longer appointment times, including longer sedation times and recovery time. Greater blood pressure (BP) variability in the preceding 20 minutes also increased the risk of hypotension.

Conclusions: Our lower incidence of hypotension is likely related to the two-pronged intervention-based definition used, as it likely more accurately reflects clinically meaningful hypotension. To our knowledge, this is the first study using this approach with this population. Research further examining the relationship between prolonged sedation, blood pressure variability, gender, hypotension, and recovery time is needed. Understanding these relationships will help interdisciplinary teams, including nurses in pediatric procedural areas, to reduce the incidence of hypotension, potentially maximize patient safety, and optimize throughput.

Keywords: adverse events; age; intravenous agents; procedural sedation; research.