J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 4, Number 6, December 2012, pages 363-370

fMRI Under Sedation: What Is the Best Choice in Children

Figure 1. Examples of activation ranking. Transversal slices in radiological convention (left hemisphere on the right side) of 8 cases with different brain activation types. Activation maps are color coded from bright yellow (highest) to red (lowest) intensities. Upper row (a to d) corresponds to activations obtained with the auditory stimulus. Lower row (e to h) corresponds to activations obtained with the visual stimulus: Rank 1, no activation in canonical areas (planum temporale for the auditory or medial occipital lobe for the visual), but some activation outside them (a, e); Rank 2, weak and scattered activation in the canonical areas, with some activation in other areas (b, f); Rank 3, small but otherwise well defined areas of activation of canonical areas (c, g); Rank 4, well defined and large activation of target areas (d, h).

**Table 1.** Patient Demographics According to Sedation Medication Administered
Item	Pen	Pen+	Pro	Dex	Dex-Pro	Sev	Total
: mg/kg; : μg/kg/m; **: μg/kg/hr. Pen was administered by bolus; Pro and Dex were administered by infusion.
N	17	13	19	24	18	9	100
Male	11	8	9	14	13	4	59
Female	6	5	10	10	5	5	41
Age mean	5.3	5.7	6.16	6.0	7.1	6.9	6.23
Age range	1 - 13	9m - 14	1 - 14	8m - 14	1 - 17	1 - 19	1 - 19
Mean dose	4.64 (*)	3.26	97.9 (**)	1.8 (***)	0.7/90	0.5 MAC
Dose range	3.0 - 8.0	2.5 - 5.0	50 - 100	0.8 (***)	0.5 - 0.9/50 - 200	0.3 - 0.75 MAC

Table 1. Patient Demographics According to Sedation Medication Administered

Item

Pen

Pen+

Pro

Dex

Dex-Pro

Sev

Total

*: mg/kg; **: μg/kg/m; ***: μg/kg/hr. Pen was administered by bolus; Pro and Dex were administered by infusion.

100

Male

Female

Age mean

5.3

5.7

6.16

6.0

7.1

6.9

6.23

Age range

1 - 13

9m - 14

1 - 14

8m - 14

1 - 17

1 - 19

Mean dose

4.64 (*)

3.26

97.9 (**)

1.8 (***)

0.7/90

0.5 MAC

Dose range

3.0 - 8.0

2.5 - 5.0

50 - 100

0.8 (***)

0.5 - 0.9/50 - 200

0.3 - 0.75 MAC

**Table 2.** Failure Rates (No Activation Obtained in Canonical (Auditory or Visual) Areas
Medication	Auditory Task	Visual Task
Pen	18% (3/17)	25% (4/16)
Pen +	38% (5/13)	15% (2/13)
Pro	21% (4/19)	39% (7/18)
Dex	25% (6/24)	46% (11/24)
Dex-Pro	28% (5/18)	11% (2/18)
Sev	44% (4/9)	44% (4/9)
Average	0.29	0.315

Table 2. Failure Rates (No Activation Obtained in Canonical (Auditory or Visual) Areas

Medication

Auditory Task

Visual Task

Pen

18% (3/17)

25% (4/16)

Pen +

38% (5/13)

15% (2/13)

Pro

21% (4/19)

39% (7/18)

Dex

25% (6/24)

46% (11/24)

Dex-Pro

28% (5/18)

11% (2/18)

Sev

44% (4/9)

Average

0.29

0.315

**Table 3.** Activation Intensity by Medication (Including Ranks 0 and 1)
	Number	Auditory mean	Auditory SD	Visual mean	Visual SD
Ranking means includes all ranks (0 to 4). (*) = Auditory and visual, respectively.
Pen	17/16(*)	3.0	1.37	2.81	1.52
Pen+	13	2.31	1.7	3.00	1.22
Pro	19/18	2.37	1.38	2.28	1.78
Dex	24	2.54	1.64	2.04	1.9
Dex-Pro	18	2.83	1.54	3.17	1.25
Sev	9	1.78	1.39	1.56	1.51
ANOVA Ho =						(Auditory) P = 0.42
					(Visual) P = 0.077

Table 3. Activation Intensity by Medication (Including Ranks 0 and 1)

Number

Auditory mean

Auditory SD

Visual mean

Visual SD

Ranking means includes all ranks (0 to 4). (*) = Auditory and visual, respectively.

Pen

17/16(*)

3.0

1.37

2.81

1.52

Pen+

2.31

1.7

3.00

1.22

Pro

19/18

2.37

1.38

2.28

1.78

Dex

2.54

1.64

2.04

1.9

Dex-Pro

2.83

1.54

3.17

1.25

Sev

1.78

1.39

1.56

1.51

ANOVA Ho =

(Auditory) P = 0.42

(Visual) P = 0.077

**Table 4.** Activation Intensity of Cases With Activation in Canonical Areas (Rank 2 to 4)
	Auditory - mean	Auditory - SD	Visual - mean	Visual - SD
The null hypothesis was not rejected for either group (Auditory: ANOVA P = 0.1; F = 1.95); (Visual: P = 0.17, F = 1.61).
Pen	3.5	0.85	3.58	0.67
Pen+	3.5	0.76	3.45	0.52
Pro	2.93	0.88	3.55	0.82
Dex	3.39	0.78	3.69	0.63
Dex-Pro	3.69	0.63	3.56	0.51
Sev	2.8	0.84	2.8	0.45
ANOVA					(A) P = 0.1
Ho =					(V) P = 0.12

Table 4. Activation Intensity of Cases With Activation in Canonical Areas (Rank 2 to 4)

Auditory - mean

Auditory - SD

Visual - mean

Visual - SD

The null hypothesis was not rejected for either group (Auditory: ANOVA P = 0.1; F = 1.95); (Visual: P = 0.17, F = 1.61).

Pen

3.5

0.85

3.58

0.67

Pen+

3.5

0.76

3.45

0.52

Pro

2.93

0.88

3.55

0.82

Dex

3.39

0.78

3.69

0.63

Dex-Pro

3.69

0.63

3.56

0.51

Sev

2.8

0.84

2.8

0.45

ANOVA

(A) P = 0.1

Ho =

(V) P = 0.12

**Table 5.** Duration of Sedation
Medication	Time - mean (minutes)	Time - SD
Pen	98.8	31.10
Pen+	144.27	17.85
Pro	126.58	37.04
Dex	148.83	28.87
Dex-Pro	151.44	13.56
Sev	140.56	22.84
ANOVA			P = 0.0005
		F = 7.85

Table 5. Duration of Sedation

Medication

Time - mean (minutes)

Time - SD

Pen

98.8

31.10

Pen+

144.27

17.85

Pro

126.58

37.04

Dex

148.83

28.87

Dex-Pro

151.44

13.56

Sev

140.56

22.84

ANOVA

P = 0.0005

F = 7.85

**Table 6.** Recovery Time
Medication	Time - mean (minutes)	Time - SD
Pen	47.0	35.67
Pen+	27.93	14.9
Pro	18.47	14.35
Dex	28.92	15.15
Dex-Pro	28.11	15.95
Sev	17.33	4.39
ANOVA			P = 0.0005
		F = 4.47

Table 6. Recovery Time

Medication

Time - mean (minutes)

Time - SD

Pen

47.0

35.67

Pen+

27.93

14.9

Pro

18.47

14.35

Dex

28.92

15.15

Dex-Pro

28.11

15.95

Sev

17.33

4.39

ANOVA

P = 0.0005

F = 4.47