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Melatonin as an alternative sedation method during magnetic resonance imaging in preschool children with musculoskeletal problems

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A Correction to this article was published on 06 June 2018

This article has been updated

Abstract

Magnetic resonance imaging (MRI) in preschool children is often challenging due to excessive motion artifacts. Sedation or general anesthesia (GA) is commonly used to prevent children from moving in the MRI scanner, with increased risk for cardiopulmonary complications and requirement for skilled personnel. Herein, we investigated whether oral melatonin, a natural hormone implicated in circadian rhythm regulation, could be used as an alternative sedation method prior to the MRI in preschool children with musculoskeletal problems. Fifteen children with suspected juvenile idiopathic arthritis underwent a total of 16 MRI examinations following administration of 10 mg of oral melatonin; satisfactory images were obtained in all but one case, with no adverse events.

Conclusion: The use of melatonin before the musculoskeletal MRI in preschool children is an effective, safe, and inexpensive alternative to standard sedation and general anesthesia in preventing motion artifacts.

What is Known:

• Magnetic resonance imaging (MRI) is a well-recognized diagnostic method to visualize synovial inflammation and changes of cartilage and bone in juvenile idiopathic arthritis.

• MRI examination requires sedation or general anesthesia to ensure immobility in children who are uncooperative.

What is New:

• Melatonin without sleep deprivation is efficacious and safe alternative to conventional sedation and general anesthesia before the musculoskeletal contrast-enhanced MRI in preschool children with JIA with timely insertion of intravenous cannula.

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Fig. 1

Change history

  • 06 June 2018

    Abstract

    Magnetic resonance imaging (MRI) in preschool children is often challenging due to excessive motion artifacts. Sedation or general anesthesia (GA) are commonly used to prevent children from moving in the MRI scanner, with increased risk for cardiopulmonary complications and requirement for skilled personnel. Herein we investigated whether oral melatonin, a natural hormone implicated in circadian rhythm regulation, could be used as an alternative sedation method prior to the MRI in preschool children with musculoskeletal problems. Fifteen children with suspected juvenile idiopathic arthritis underwent a total of 16 MRI examinations following administration of 10 mg of oral melatonin; satisfactory images were obtained in all but one case, with no adverse events.Conclusion: The use of melatonin before the musculoskeletal MRI in preschool children is an effective, safe and inexpensive alternative to standard sedation and general anesthesia in preventing motion artifacts.

    What is known:

    • Magnetic resonance imaging (MRI) is a well-recognized diagnostic method to visualize synovial inflammation and changes of cartilage and bone in juvenile idiopathic arthritis.

    • MRI examination requires sedation or general anesthesia to ensure immobility in children who are uncooperative.

    What is new:

    • Additional to previous published studies we were able to show that melatonin for sedation for an MRI of joints, even without sleep deprivation, in the studied population may provide an alternative in children without behavioral problems, in order to avoid sedation/GA.

Abbreviations

GA:

General anesthesia

JIA:

Juvenile idiopathic arthritis

MRI:

Magnetic resonance imaging

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Authors and Affiliations

  1. Children’s Hospital Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia

    Agneza Marija Pasini, Goran Roić, Nikola Dukarić, Ana Tripalo Batoš, Zoran Bahtijarević & Alenka Gagro

  2. Department of Radiology, Royal Belfast Hospital for Sick Children, Belfast, UK

    Josip Marjanović

  3. Faculty of Medicine, Josip Juraj Strossmayer, University of Osijek, Osijek, Croatia

    Alenka Gagro

  4. Department of Pulmonology, Allergology, Immunology and Rheumatology, Department of Pediatrics, Children’s Hospital Zagreb, Zagreb, Croatia

    Alenka Gagro

Authors
  1. Agneza Marija Pasini
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  2. Josip Marjanović
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  3. Goran Roić
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  4. Nikola Dukarić
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  5. Ana Tripalo Batoš
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  6. Zoran Bahtijarević
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  7. Alenka Gagro
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Contributions

Agneza Marija Pasini: Dr. Pasini conceptualized and drafted the initial manuscript, approved the final manuscript.

Josip Marjanović: Dr. Marjanović helped with the radiologic procedures and findings and making the diagnosis, writing the initial manuscript, and critically revised the manuscript.

Goran Roić: Dr. Roić helped with the radiologic procedures and findings and making the diagnosis, writing the initial manuscript, and critically revised the manuscript.

Nikola Dukarić: Dr. Dukarić helped with the radiologic procedures and findings and making the diagnosis, writing the initial manuscript.

Ana Tripalo Batoš: Dr. Tripalo Batoš helped with the radiologic findings and making the diagnosis, writing the initial manuscript.

Zoran Bahtijarević: Dr. Bahtijarević was involved in making the diagnosis, follow-up of the patient, and writing the initial manuscript.

Alenka Gagro: Dr. Gagro conceptualized initial manuscript, critically revised the manuscript, approved the final manuscript.

Corresponding author

Correspondence to Alenka Gagro.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Communicated by Nicole Ritz

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Pasini, A.M., Marjanović, J., Roić, G. et al. Melatonin as an alternative sedation method during magnetic resonance imaging in preschool children with musculoskeletal problems. Eur J Pediatr 177, 1359–1362 (2018). https://doi.org/10.1007/s00431-017-3069-7

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  • DOI: https://doi.org/10.1007/s00431-017-3069-7

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