Two Anesthetic Strategies for Pediatric Magnetic Resonance Imaging: Face-Mask Sevoflurane versus an Intravenous Propofol-Ketamine Regimen in a Randomized Parallel-Group Trial
In brief
Propofol-ketamine shortened children's MRI recovery by about one minute
In a single-center randomized trial of 211 children, propofol-ketamine reduced average recovery time by about one minute compared with face-mask sevoflurane, but required more frequent anesthetic escalation. Children receiving propofol-ketamine also had lower emergence-delirium scores; discharge time, image quality, and measured safety outcomes did not differ. The clinical importance of these modest differences remains uncertain.
- Journal
- Medical principles and practice : international journal of the Kuwait University, Health Science Centre (Q1)
- Published
- 12 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Bedirhan Gunel, Ahmet Ergun, Nurseda Dundar, Gozde Gamze Uzun, Mehmet Yilmaz
- PMID
- 42862798
- DOI
- 10.1159/mpp/adpag031
Why clinicians should know about it
- Picked for Anesthesiology and Pain Medicine (paper of the day, 13 October 2026): Propofol‑ketamine vs sevoflurane, pediatric MRI anesthesia
Abstract
OBJECTIVE: To compare recovery time between two complete anesthetic strategies for pediatric magnetic resonance imaging: face-mask sevoflurane maintenance and intravenous ketamine-propofol induction followed by intermittent supplemental propofol boluses. SUBJECTS AND METHODS: In this single-center randomized trial, 230 children aged 3 months to 10 years were assigned to propofol-ketamine (Group P) or sevoflurane (Group S). After 19 post-randomization exclusions, 211 participants were analyzed per protocol (Group P, n = 106; Group S, n = 105). The primary outcome was recovery time; secondary outcomes included protocol-specific anesthetic escalation, discharge time, respiratory and hemodynamic events, image quality, and peak Pediatric Anesthesia Emergence Delirium (PAED) score. RESULTS: Recovery time was shorter in Group P (means, 4.46 vs. 5.31 min; 5% trimmed-mean difference [Group S minus Group P], 1.05 min; 95% CI, 0.17-1.94; p = 0.020). Protocol-specific anesthetic escalation was more frequent in Group P (29.2% vs. 11.4%; risk difference, 17.8 percentage points; 95% CI, 7.0-28.2; p = 0.001), whereas peak PAED scores were lower in Group P (Hodges-Lehmann location-shift estimate, -2; 95% CI, -4 to -1; p < 0.001). No between-group differences were detected in discharge time, image quality, or respiratory and hemodynamic outcomes. CONCLUSION: Propofol-ketamine was associated with a small, approximately one-minute shorter recovery time and more frequent protocol-specific anesthetic escalation, whereas face-mask sevoflurane was associated with higher peak PAED scores. Because no minimal clinically important differences were prespecified, their clinical and operational importance remains uncertain. Nonsignificant safety findings do not establish equivalent safety.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.