A Prospective, Randomised Study Comparing the Safety of Sedation with and without Prophylactic Placement of Nasopharyngeal Airway in Children Undergoing Magnetic Resonance Imaging

Background: One of the common indications for non-operating room anaesthesia is magnetic resonance imaging (MRI) in children. Titration of sedation to avoid airway obstruction and, at the same time, keep the child immobile is challenging. The paediatric Sedation Research Consortium has concluded that the most common complications in such settings are airway-related. The child’s airway is inaccessible, making it difficult to perform airway interventions to relieve obstruction. Inserting an airway conduit prophylactically can ensure a patent airway, limiting airway-related events. Our study aims to compare the safety of sedation in MRI with and without a prophylactic nasopharyngeal airway. We also analyzed the anesthesiologist’s comfort level. 
Methods: Children aged between 0 and 18 years scheduled for an MRI were included. Group A received sedation with a nasopharyngeal airway in place, and Group B received sedation without an airway adjunct. The sedation protocol consisted of intravenous midazolam (0.04 mg/kg) followed by propofol (2 mg/kg). Sedation was maintained with boluses of propofol at 1 mg/kg.
Results: There was a significant difference in MRI duration (33 minutes in Group A vs 37 minutes in Group B), with a p-value of 0.03. The mean propofol dose required was 5.5 mg/kg in Group A and 5.2 mg/kg in Group B; although not statistically significant, these values ensured adequate sedation without risk of airway loss. When analyzed the comfort level of the anesthesiologists providing the sedation objectively on a Likert scale of 0-5, we found a highly significant difference between groups.
Conclusion: We observed that the use of a prophylactic nasopharyngeal airway not only improved safety but also reduced MRI duration due to adequate dosing and minimal interruptions. Better respiratory monitoring, the ability to achieve adequate sedation levels, and fewer interruptions translated into a high comfort level for the anaesthesiologist providing sedation.