BACKGROUND Children require anesthesia for MRI to maintain immobility and reduce discomfort; clear indications about the best anesthesiologic management are lacking and each center developed its own protocol. Moreover, children with neuropsychiatric disorders more likely require sedation and are described in literature as more prone to general and respiratory complications. Aim of this study was to analyze the applicability of a sevoflurane-based approach, to describe general and respiratory complications and to identify risk factors in a pediatric neuropsychiatric population. METHODS Retrospective cohort study, university Hospital (January 2007-December 2016). All the 1469 anesthesiologic records of children addressed from Neuropsychiatric Unit to undergo MRI under general anesthesia were analyzed; 12 patients equal or older than 18-year-old were excluded. We identified post-hoc nine macro-categories: static encephalopathies, metabolic/evolutive encephalopathies, epileptic encephalopathies, neuromuscular diseases, autistic spectrum disorders, migraine, psychiatric disorders, intellectual disabilities, others. A logistic regression model for events with low frequency (Firth's penalized likelihood approach) was carried out to identify the mutually adjusted effect among endpoints (complications) and the independent variables chosen on the basis of statistical significance (univariate analysis, p ≤ 0.05) and clinical judgment. RESULTS Of 1457 anesthesiologic records (age 4.0 (IQR 2.0 to 7.0) year-old, males 891 (61.2%), weight 17.0 (IQR 12.0 to 24.9) kg), 18 were cancelled for high anesthesiologic risk, 50 were cooperative, 1389 were anesthetized. A sevoflurane-based anesthesia was feasible in 92.3%; these patients required significantly less mechanical ventilation (8.6 vs. 16.2%; p = 0.012). Complications' rate was low (6.2%; 3.1% respiratory). The risk for general complications increases with ASA score > 1 (OR 2.22, 95 CI% 1.30 to 3.77, p = 0.003), male sex (OR 1.73, 95% CI 1.07 to 2.81, p = 0.025), multi-drug anesthesia (OR 2.98, 95 CI% 1.26 to 7.06, p = 0.013). For respiratory complications, it increases with ASA score > 1 (OR 2.34, 95 CI% 1.19 to 4.73, p = 0.017), autumn-winter (OR 2.01, 95 CI% 1.06 to 3.78, p = 0.030), neuromuscular disorders (OR 3.18, 95 CI% 1.20 to 8.41, p = 0.020). We had no major complications compromising patients' outcome or requiring admission to ICU. CONCLUSIONS Sevoflurane anesthesia is feasible and safe for children affected by neuropsychiatric disorders undergoing MRI. Specific risk factors for general and respiratory complications should be considered.

中文翻译：

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在患有神经精神疾病的儿童中使用七氟醚进行MRI的非手术室标准化麻醉的十年经验。

背景技术儿童需要进行MRI麻醉以保持不动并减少不适感。缺乏关于最佳麻醉学管理的明确指示，每个中心都制定了自己的协议。此外，患有神经精神疾病的儿童更可能需要镇静，并且在文献中被描述为更容易出现一般和呼吸系统并发症。这项研究的目的是分析基于七氟醚的方法的适用性，以描述一般和呼吸系统并发症，并确定小儿神经精神病人群的危险因素。方法回顾性队列研究，大学医院（2007年1月至2016年12月）。分析了在全麻下由神经精神科接受MRI检查的所有1469例儿童的麻醉记录；排除12名等于或大于18岁的患者。我们确定了事后9个宏观类别：静态脑病，代谢/进化性脑病，癫痫性脑病，神经肌肉疾病，自闭症，偏头痛，精神病，智力障碍等。进行了低频事件的逻辑回归模型（Firth的惩罚似然法），以识别终点（并发症）之间的相互调节作用以及根据统计学意义（单因素分析，p≤0.05）和临床选择的独立变量判断。结果在1457例麻醉学记录中（4.0岁（IQR 2.0至7.0岁），男性891（61.2％），体重17.0（IQR 12.0至24.9）kg）被取消了高麻醉风险的18例，合作的50例，1389年被麻醉。以七氟醚为基础的麻醉可行率为92.3％。这些患者所需的机械通气量明显减少（8.6比16.2％； p = 0.012）。并发症发生率很低（6.2％；呼吸系统为3.1％）。一般并发症的风险随着ASA评分> 1（OR 2.22，95 CI％1.30至3.77，p = 0.003），男性（OR 1.73，95％CI 1.07 to 2.81，p = 0.025），多药麻醉（ OR 2.98，95 CI％1.26至7.06，p = 0.013）。对于呼吸系统并发症，其随着ASA得分> 1（OR 2.34，95 CI％1.19至4.73，p = 0.017），秋冬（OR 2.01，95 CI％1.06至3.78，p = 0.030），神经肌肉疾病（OR）而增加。 3.18，95 CI％1.20至8.41，p ＝ 0.020）。我们没有严重的并发症会危及患者的预后或需要入住ICU。结论七氟醚麻醉对于接受MRI治疗的神经精神疾病的患儿是可行且安全的。应考虑一般和呼吸系统并发症的特定危险因素。