Evidence map›Paper›PMID 37563320›Full record

ArticlePediatric radiology2023

Tolerability and efficacy of a reduced dose adenosine stress cardiac magnetic resonance protocol under general anesthesia in infants and children.

Madhusudan Ganigara, Bharti Sharma, Pezad Doctor, Mohamed Nagiub, Sanja Dzelebdzic, Roby Sebastian, Munes Fares, Jeanne Dillenbeck, Gerald Greil, Tarique Hussain

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Article in Pediatric radiology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
0.6field-weighted citation impact, top 30% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 2 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 4 institutions in 1 country.

Madhusudan GanigaraDivision of Pediatric Cardiology, Department of Pediatrics, The University of Chicago & Biological Sciences, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA. mganigara@bsd.uchicago.edu.ORCID 0000-0001-6083-4355
Bharti SharmaDepartment of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Pezad DoctorDivision of Pediatric Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Mohamed NagiubDivision of Pediatric Cardiology, University of Virginia Technology, Roanoke, VA, USA.
Sanja DzelebdzicDivision of Pediatric Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Roby SebastianDivision of Pediatric Anesthesia, Department of Anesthesia, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Munes FaresDivision of Pediatric Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Jeanne DillenbeckDivision of Pediatric Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Gerald GreilDivision of Pediatric Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Tarique HussainDivision of Pediatric Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA.
The University of Texas Southwestern Medical Center · USIcahn School of Medicine at Mount Sinai · USUniversity of Chicago · USUniversity of Virginia · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundIntravenous adenosine induces pharmacological stress by causing vasodilatation and thus carries the risk of severe hypotension when combined with vasodilatory effects of anesthetic agents.

objectiveThis study describes our experience with a reduced dose adenosine cardiac magnetic resonance imaging (MRI) protocol in young children under general anesthesia (GA). MATERIALS AND

methodsThis is a retrospective report of all patients from birth to 18 years who underwent adenosine stress cardiac MRI under GA between August 2018 and November 2022. Based on our anecdotal experience of severe adverse effects in patients receiving adenosine infusion under GA and in discussion with the pediatric anesthesia team, we developed a modified protocol starting at a dose of 110 mcg/kg/min with incremental escalation to a full dose of 140 mcg/kg/min to achieve desired hemodynamic effect.

resultsTwenty-two children (mean age 6.5 years, mean weight 28 kg) satisfied the inclusion criteria. The diagnoses included Kawasaki disease (7), anomalous aortic origin of left coronary artery (3), anomalous aortic origin of right coronary artery (2), coronary fistula (3), repaired d-transposition of great arteries (2), repaired anomalous left coronary artery from pulmonary artery (2), repaired truncus arteriosus with left coronary artery occlusion (1), extracardiac-Fontan with left coronary artery myocardial bridge (1), and post heart transplantation (1). Nine patients needed dose escalation beyond 110 mcg/kg/min. Two patients had transient hypotension during testing (systemic blood pressure drop > 25 mmHg). No patient developed significant heart block or bronchospasm. Six patients (repeat study in one) demonstrated inducible perfusion defects (27%) on stress perfusion sequences-5 of whom had confirmed significant coronary abnormalities on angiography or direct surgical inspection.

conclusionA reduced/incremental dose adenosine stress cardiac MRI protocol under GA in children is safe and feasible. This avoids severe hypotension which is both unsafe and may result in inaccurate data.

Indexed as

AdenosineAnesthesia, GeneralHeart Defects, CongenitalMagnetic Resonance ImagingVasodilator AgentsAdolescentChildChild, PreschoolFemaleHumansInfantInfant, NewbornMaleRetrospective StudiesAdenosineVasodilator AgentsAdenosineCardiac magnetic resonance imagingChildGeneral anesthesiaHypotensionStress perfusionVasodilation

Identifiers

PMID37563320
OpenAlexW4385718039

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.