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The purpose of this review is to focus on recent literature about sedation or anaesthesia in paediatric MRI. Special features of the MRI working environment, recent studies about sedation or anaesthesia, and success rates and risk profiles in this setting are presented. Finally, information for physicians to decide between sedation or anaesthesia in individual situations is presented.Owing to advances in MRI and its crucial role in the diagnosis of various diseases, deep sedation or anaesthesia for MRI in children is requested increasingly. According to current guidelines maximum patient safety and welfare has to be ensured. Recently different sedation regimens comparing effectiveness, safety and outcome have been published. Chloral hydrate, pentobarbital and midazolam are unfavourable for MRI sedation. Dexmedetomidine appears to be convenient for sedation in patients without cardiac risk. Propofol can be effectively used for sedation or anaesthesia in the presence of anaesthesiologists or paediatric intensivists. General anaesthesia should be preferred in preterm or small children as safety and success are predictable.The MRI unit is a work station where all processes have to be well planned and staff trained to guarantee maximum patient safety, superior quality of imaging and economic needs. For optimal performance trained, experienced and certified personnel, appropriate drugs for the individual patient risk profile and sufficient monitoring equipment are essential.