Russian Journal of Pediatric Surgery, Anesthesia and Intensive CareRussian Journal of Pediatric Surgery, Anesthesia and Intensive CareРоссийский вестник детской хирургии, анестезиологии и реаниматологии2219-40612587-6554Eco-Vector55310.30946/2219-4061-2019-9-2-97-104ReviewsОбзорыRole of an anesthesiologist in pediatric X-ray diagnosticsРоль анестезиолога в проведении магнитно-резонансной томографии у детейIakovlevaEkaterina S.ЯковлеваЕ. С.
Russian Federation

Anesthesiologist, Scientific practical center of pediatric psychoneurology

Michurinskij highway, 74, Moscow, 119602; phone: +7 (495) 430–80–8

Яковлева Екатерина Сергеевна - врач анестезиолог-реаниматолог 

Мичуринский проспект, д. 74, г. Москва, 119602; тел.: 8 (495) 430–80–83

iakovlevadoc@gmail.comLazarevVladimir V.ЛазаревВ. В.
Russian Federation

Dr. Sci (Med), Professor, Chairman of the Department of Pediatric Anesthesiology and Intensive Care

Ostrovityanov 1, Moscow, 117997; phone: +7(495) 936–90–65

Лазарев Владимир Викторович - доктор медицинских наук, профессор, заведующий кафедрой детской анестезиологии и интенсивной терапии

ул. Островитянова, д. 1, г. Москва, 117997; тел.: 8 (495) 936–90–65

lazarev_vv@inbox.ruDiordievAndrey V.ДиориевА. В.
Russian Federation

Dr. Sci (Med), Professor, Head of the Department of Anesthesiology and Critical Care, Medicine of Scientific practical center of pediatric psychoneurology

Michurinskij highway, 74, Moscow, 119602; phone: +7 (495) 430–80–83

Диордиев Андрей Викторович - доктор медицинских наук, профессор, заведующий отделением анестезиологии-реаниматологии 

Мичуринский проспект, д. 74, г. Москва, 119602; тел.: 8 (495) 430–80–83

Science and Practical Center of Children Psychoneurology of the Moscow City Health DepartmentНПЦ детской психоневрологии Департамента здравоохранения г. МосквыPirogov Russian National Research Medical UniversityРоссийский национальный исследовательский медицинский университет имени Н. И. Пирогова1608201992971041508201915082019Copyright ©; 2019, Iakovleva E.S., Lazarev V.V., Diordiev A.V.Copyright ©; 2019, Яковлева Е.С., Лазарев В.В., Диориев А.В.2019Iakovleva E.S., Lazarev V.V., Diordiev A.V.Яковлева Е.С., Лазарев В.В., Диориев А.В.https://creativecommons.org/licenses/by-nc-nd/4.0https://rps-journal.ru/jour/article/view/553

Purpose: analysis of modern data devoted to the issue of stress-free and safe magnetic resonance imaging in children using both non-drug methods and different agents for anesthesia along with their delivery systems.

Discussion. It is difficult to complete MRI in younger children due to some reasons and possible development of stress. The technique often requires the presence of an anesthesiologist, especially if patients present with neurological pathology. The article describes how to deal with this problem to ensure safety and comfort during the procedure at the X-ray diagnostic department.

Conclusions: a broad spectrum of non-drug methods is available and successfully used today. Different types of sedation and anesthesia ensure safety and comfort of a patient who undergoes an examination at the X-ray diagnostic department.

Цель: анализ современных данных, посвящённых проблеме бесстрессового и безопасного проведения магнитно-резонансной томографии у детей как немедикаментозными способами, так и с использованием различных препаратов для анестезии и средств их доставки.

Обсуждение. Проведение магнитно-резонансной томографии у детей младшего возраста затруднительно по ряду причин и сопряжено с развитием у них различных стрессовых реакций. Зачастую проведение исследования без помощи анестезиолога становится невозможным в особенности, когда речь идёт о пациентах с неврологической патологией. В статье описаны способы решения данной проблемы, которые позволяют обеспечить безопасность и комфорт при проведении исследований в отделении рентгенодиагностики.

Выводы: на сегодняшний день существует и успешно применяется широкий спектр немедикаментозных методов, а также различных видов седации и анестезии, направленных на обеспечение не только безопасности, но и комфорта пациента при проведении обследований в отделении рентгенодиагностики.

magnetic resonance imagingchildrenneurological disturbancesanesthesiasedationpostanesthetic agitationмагнитно-резонансная томографиядетиневрологические расстройстваанестезияседацияпосленаркозная ажитация1. Making Imaging Centers Child Friendly. Kaplan D. A.. Diagnosticimaging.com; 2014 [07.02.2014]. Доступно: http://www.diagnosticimaging.com/pediatric-imaging/making-imaging-centers-child-friendly2. Runge S. B., Christensen N. L., Jensen K, Jensen I. E. Children centered care: Minimizing the need for anesthesia with a multi-faceted concept for MRI in children aged 4-6. European journal of radiology. 2018: 10: 183-187. https://doi.org/10.1016/j.ejrad.2018.08.026.3. Tan L., Meakin G. H. Anaesthesia for the uncooperative child. Continuing Education in Anaesthesia Critical Care & Pain. 2010; 10(2): 48-52. https://doi.org/10.1046/j.1460-9592.1998.00263.x4. Messeri A., Caprilli S., Busoni P. Anaesthesia induction in children: a psychological evaluation of the efficiency of parents’ presence. Paediatric Anaesthesia. 2004; 14(7): 551-6. DOI:10.1111/j.1460-9592.2004.01258.x.5. O’Sullivan M., Wong G. K. Preinduction techniques to relieve anxiety in children undergoing general anaesthesia. Continuing Education in Anaesthesia Critical Care & Pain. 2013; 13(6); 196-1996. Lam C., Udin R. D., Malamed S.F, Good D. L., Forrest J. L. Midazolam Premedication in Children: A Pilot Study Comparing Intramuscular and Intranasal Administration. Anesthesia Progress. 2005; 52(2): 56-61. https://doi.org/10.2344/0003-3006(2005)52[56:MPICAP]2.0.CO;2.7. Griffith N., Howel S., Mason D. G. Intranasal Midazolam for premedication of children undergoing day-case anesthesia comparison of two delivery systems with assessment of intra-observer variability. British journal of Anaesthesia. 1998; 81: 865-9. DOI:10.1111/j.1365-2044.1997.120-az0122.x.8. Диордиев А. В., Айзенберг В. Л., Яковлева Е. С. Анестезия у больных церебральным параличом. Журнал Регионарная анестезия и лечение острой боли. 2015; 9(3): 29-369. Giudice E., Staiano A., Capano G., Romano A., Florimonte L., Miele E., Ciarla C., Campanozzi A., Crisanti A. F. Gastrointestinal manifestations in children with cerebral palsy. Brain & Development. 1999; 21(5): 307-11. https://doi.org/10.1016/S0387-7604(99)00025-X.10. Schrier L., Zuiker R., Merkus F. W.H.M., Klaassen E. S., Guan Z., Tuk B., van Gerven J. M.A., van der Geest R., Groene veld G. J. Pharmacokinetics and pharmacodynamics of a new highly concentrated intranasal midazolam formulation for conscious sedation. British Journal of Clinical Pharmacology. 2016; 83(4): 721-31. https://doi.org/10.1111/bcp.13163.11. Tobias J. D. Dexmedetomidine: Applications in Pediatric Critical Care & Pediatric Anesthesiology. Pediatric Critical Care and Medicine. 2007; 8(2): 115-31. DOI:10.1097/01.PCC.0000257100.31779.4112. Mukherjee A., Das A., Basunia S. R., Chattopadhyay S., Kundu R., Bhattacharyya R. Emergence agitation prevention in pediatric ambulatory surgery: A comparison between intranasal Dexmedetomidine and Clonidine. Journal of Research in Pharmacy Practice. 2015; 4(1): 24-30. DOI: 10.4103/2279-042X.150051.13. Mason K. P., Lerman J. Dexmedetomidine in Children: Current Knowledge and Future Applications. Anesthesia & Analgesia. 2011; 113(5): 1129-42. DOI: 10.1213/ANE.0b013e31822b8629.14. Qiao H., Xie Z., Jia J. Pediatric premedication: a double-blind randomized trial of dexmedetomidine or ketamine alone versus a combination of dexmedetomidine and ketamine. BMC Anesthesiology.2017; 17(1): 158. DOI: 10.1186/s12871-017-0454-8.15. Cohen M. S., Aboulleish A. E., Mueller M., Elkon D. Intranasal Dexmedetomidine for Sedation during CT Scanning. Asaabstracts.com 2008 [20.10.2008]. Доступно: http://www.asaabstracts.com/strands/asaabstracts/abstract.htm?year=2008&index=16&absnum=31016. Gokhan Olgun, Mir Hyder Ali. Use of Intranasal Dexmedetomidine as a Solo Sedative for MRI of Infants. Hospital Pediatrics. 2018; 8(2). pii: hpeds. 2017-0120. DOI:10.1542/hpeds.2017-0120.17. Schoeler M., Loetscher P. D., Rossaint R. Dexmedetomidine is neuroprotective in an in vitro model for traumatic brain injury. BMC Neurology. 2012; 12: 20. https://doi.org/10.1186/1471-2377-12-20.18. Loepke A. W.. Developmental neurotoxicity of sedatives and anesthetics: a concern for neonatal and pediatric critical care medicine? Pediatric Critical Care Medicine. 2010; 11(2): 217-26. DOI: 10.1097/PCC.0b013e3181b80383.19. GoaK L., Noble S., Spencer C. M. Sevoflurane in paediatric anaesthesia: a review. Paediatric Drugs. 1999; 1(2): 127-53. DOI:10.2165/00128072-199901020-0000520. Aono J., Ueda W., Mamiya K., Takimoto E., MD; Masanobu Manabe, MD. Greater Incidence of Delirium during Recovery from Sevoflurane Anesthesia in Preschool Boys. Anesthesiology. 1997; 12(87): 1298-300.21. Moore A. D., Anghelescu D. L.. Emergence Delirium in Pediatric AnesthesiaPaediatric Drugs. 2017;19(1):11-20. DOI: 10.1007/s40272-016-0201-5.22. Allopi K. Emergence delirium in. children. Commentator: S Roberts Moderator: C Kampik. Department of Anaesthetics. 2012; 30: 2-22.23. Abu-Shahwan I. Effect of propofol on emergence behavior in children after sevoflurane general anesthesia. Paediatric Anaesthesia. 2008; 18(1): 55-9. DOI:10.1111/j.1460-9592.2007.02376.x24. Messieha Z. Prevention of Sevoflurane Delirium and Agitation With Propofol. Anesthesia Progress. 2013; 60(2): 67-71. DOI:10.2344/0003-3006-60.3.67.25. Kain Z. N., Maclaren J., Mayes L. C. Perioperative Behavior Stress in Children. In: Cote C. J., Lerman J. and Todres I. D. Eds. A Practice of Anesthesia for Infants and Children. 2009. Philadelphia, PA: Saunders Elsevier 27.26. Yuki K., Matsunami E., Tazawa K., Wang W., DiNardo J.A., Koutsogiannaki S. Pediatric Perioperative Stress Responses and Anesthesia. Does a prophylactic dose of propofol reduce emergence agitation in children receiving anesthesia? A systematic review and meta-analysis. Paediatric Anaesthesia. 2015; 25(7): 668-76. https://doi.org/10.1111/pan.1266927. Van Hoff S. L., O’Neill E.S., Cohen L. C., Collins B. A. Does a prophylactic dose of propofol reduce emergence agitation in children receiving anesthesia? A systematic review and meta-analysis. Paediatric Anaesthesia. 2015; 25(7): 668-76. DOI: 10.1111/pan.1266928. Aouad M. T., Yazbeck-Karam V.G., Nasr V. G., El-Khatib M.F., Kanazi G. E., Bleik J. H. A single dose of propofol at the end of surgery for the prevention of emergence agitation in children undergoing strabismus surgery during sevoflurane anesthesia. Anesthesiology. 2007; 107(5): 733-8. DOI: 10.1097/01.anes.0000287009.46896.a729. Costi D., Ellwood J., Wallace A., Ahmed S., Waring L., Cyna A. Transition to propofol after sevoflurane anesthesia to prevent emergence agitation: a randomized controlled trial. PaediatricAnaesthesia. 2015; 25(5): 517-23. DOI: 10.1111/pan.12617.30. Dahmani S., Delivet H., Hilly J. Emergence delirium in children: an update. Current Opinion in Anaesthesiology. 2014; 27(3): 309-15. DOI:10.1097/ACO.0000000000000076.31. Youn A. M., KoY-K., KimY-H. Anesthesia and sedation outside of the operating room. Korean Journal of Anesthesiology. 2015; 68(4): 323-1. https://doi.org/10.4097/kjae.2015.68.4.323.