Original Article
The Effects of Anesthesia on the Pediatric Developing Brain: Strategies to Reduce Anesthesia Use in Pediatric MRI and Nursing's Role in Driving Patient Safety

https://doi.org/10.1016/j.jopan.2019.02.007Get rights and content

Purpose

To describe the physiological and biological principles of anesthesia for children; nonanesthesia practices; the state of the evidence of patient- and family-centered care strategies to reduce anesthesia use; and role of nursing in ensuring patient safety through reducing anesthesia use for pediatric magnetic resonance imaging (MRI).

Design

Integrative literature review.

Methods

Review and synthesis of experimental and nonexperimental literature.

Findings

Anesthesia use in pediatric MRI: 20 studies met inclusion criteria. Physiological and biological side effects of anesthesia in children are substantial. Of significance is the developing research on the extent to which anesthesia affects the developing brain of children. Nonanesthesia in pediatric MRI: 16 studies met inclusion criteria. Common themes were noted between patient- and family-centered care strategies and reducing anesthesia use in children requiring MRI.

Conclusions

There are significant risks associated with anesthesia on the developing brain. Nurses play an important role in using patient-centered strategies to reduce pediatric anesthesia use and advocate for patient safety.

Section snippets

Identification of Studies and Study Selection

A search of the scientific literature was conducted using research databases such as CINAHL, Academic Search Premier, PubMed, PsychINFO, AMED, the Cochrane Library, Ovid, and MEDLINE to ensure that all the literature pertaining to the fields of pediatric sedation and physiological implications and child life was included in the review. All reviews included the peer-reviewed literature from January 2005 through June 2015, and abstracts were reviewed to determine eligibility for inclusion.

Risks and Side Effects of Anesthetic Agents Used for Children in MRI

The literature presented the efficacy, risks, and side effects associated with the pharmacologic agents used to sedate or anesthetize children needing an MRI. Common drugs used for MRI sedation include chloral hydrate, dexmedetomidine, midazolam-pentobarbital-fentanyl combination, isoflurane, sevoflurane, nitrous oxide, and propofol.9, 10, 11, 12, 13, 14 Incident of side effects from the drugs used for sedation or anesthesia in children for MRI range in occurrence. Potential side effects

Conclusions

The primary rationale for the use of sedation or GA in MRI is to ensure that the child remains still for the duration of time while the scan is being conducted. However, the use of sedation or GA is not benign and has real physiological and biological side effects for children. The safety risks and side effects of anesthetic agents used for children requiring an MRI include ED, respiratory depression, oxygenation, nausea, vomiting, agitation, and cardiovascular bradycardia. Of growing concern

Kari A. Mastro, PhD, RN, NEA-BC, Center for Health Services Research and Policy, Rutgers School of Nursing, Newark, NJ, and St. Mary Medical Center, Langhorne, PA

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    • Kari A. Mastro, PhD, RN, NEA-BC, Center for Health Services Research and Policy, Rutgers School of Nursing, Newark, NJ, and St. Mary Medical Center, Langhorne, PA

    Linda Flynn, PhD, RN, FAAN, Center for Health Services Research and Policy, Rutgers School of Nursing, Rutgers The State University of New Jersey, Newark, NJ

    Christa Preuster, MSN, RN, PMHCNS-BC, Rutgers School of Nursing, Rutgers The State University of New Jersey, Newark, NJ, and Columbia University, School of Nursing, New York City, NY

    Lisa Summers-Gibson, MSN-ED, RN, CDE, NEA-BC, St. Mary Medical Center, Langhorne, PA

    Mark H. Stein, MD, Department of Anesthesiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ

    Conflict of Interest: None to report.

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    © 2019 by American Society of PeriAnesthesia Nurses