Handling Section Editor : Prof Britta von Ungern-Sternberg Serious airway-related adverse events with sevoflurane anesthesia via facemask for magnetic resonance imaging in 7129 pediatric patients: a retrospective study.

Objective This retrospective study evaluated the safety and effectiveness of sevoflurane anesthesia by facemask for magnetic resonance imaging (MRI) scanning among pediatric patients in a high-volume MRI department. Methods The medical records of 7129 pediatric patients (median age 12 months, range 4.0-36.0 months) who were administered anesthesia during MRI scanning were reviewed. Anesthesia via 8% and 1.5%-2% sevoflurane was used for induction and maintenance, respectively. All the patients were monitored by anesthetists in the postanesthesia care unit. Vital signs were recorded every 5 minutes. Airway-related adverse events, sevoflurane induction time, MRI scanning time, and recovery time were recorded. Patients were discharged when no complications were found for 10-15 minutes, with Aldrete's score >= 9. Results After sevoflurane anesthesia, there were 28 severe airway-related adverse events (0.4%, 95% CI: 0.2%-0.5%), and 12 patients had severe respiratory apnea (0.2%, 95% CI: 0.1%-0.2%). The percentage of patients with respiratory apnea was significantly higher in preterm infants compared with term infants (2.4% cf. 0.5%, P = 0.012). Sixteen patients had severe airway obstruction (0.2%, 95% CI: 0.1%-0.3%). Conclusion The major severe airway-related adverse events among pediatric patients associated with sevoflurane anesthesia were respiratory apnea and airway obstruction. The respiratory condition of preterm infants should be monitored carefully when under sevoflurane anesthesia. Overall, sevoflurane is safe and can be used efficiently for pediatric anesthesia in high-volume MRI departments.