Evaluating the Effects of Propofol vs. Dexmedetomidine

There are several different medications commonly being used to facilitate the administration
of radiologic procedures on children. Procedures such as Magnetic Resonance Imaging (MRIs)
require that the patient remain still for the duration of the test. Propofol has become the
drug of choice for many sedation services due to its rapid onset of action, rapid recovery
time, ability to achieve sedation reliably and favorable safety profile. Dexmedetomidine, a
selective alpha-2- adrenergic agonist, has also gained popularity with sedation services. Its
main advantage over propofol is that it has minimal respiratory complications when compared
to propofol. The sedative effect from dexmedetomidine preserves a natural sleep pattern and
induces cooperative sedation in which patients are easily arousable. In pediatric studies,
the most frequent adverse effect have been related to its potential to cause hypotension and
bradycardia, which resolve with dose reduction. Additionally, dexmedetomidine does not seem
to have as much impairment of cognitive function and has an opioid sparing effect.
Dexmedetomidine, however, has a longer onset of action and longer recovery time compared to
propofol, which has limited its use with many sedation services.

Inclusion Criteria:

1. Patient (or Parent/Guardian) is English speaking

2. Patient is undergoing a scheduled, elective non-contrast MRI of the brain

3. Patient is > 3 months to <36 months of age

Exclusion Criteria:

1. Patients undergoing MRI with contrast

2. Patients older than 36 months of age or younger than 3 months of age

3. Patients presenting to Emergency Department (ED) out of screening hours

4. Patients who are not English speaking

5. Patients who have history or record of propofol or dexmedetomidine allergy

6. Patients with known or history of anaphylaxis to eggs, egg products, soybeans, or soy
based products; if patient has a history of a hypersensitivity reaction associated
with exposure to eggs, egg products, soybeans, or soy based products, approval must be
given by the treating attending physician and documented on the patient's medical
record.

7. Patients with unstable cardiac or respiratory status as determined by treating
attending physician

8. Patients who are receiving digoxin