Junyi Ren¹,², Joel Moyo², Blessed Kondowe³,Patrick Manda³, Jingping Zhang⁴,³, Lin Liu*⁵,⁶
- Department of Anesthesiology, Baoji Central Hospital, Baoji, China
- Department of Anesthesiology, Mzuzu Central Hospital, Mzuzu, Malawi
- Department of Radiology, Mzuzu Central Hospital, Mzuzu, Malawi
- Department of Medical Imaging, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Department of Anesthesiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- Department of Anesthesiology, Kamuzu Central Hospital, Lilongwe, Malawi
*Corresponding Author: Lin Liu; E-mail: liulinqoo@163.com
Abstract
Magnetic resonance imaging (MRI) in young infants requires effective immobilization to ensure diagnostic image quality. Although non-pharmacological approaches such as the feed-and-swaddle technique are widely recommended, they are not always successful. Sedation in neonates remains controversial, particularly in resource-limited settings. This study aimed to evaluate the feasibility and observed safety profile of intramuscular ketamine for MRI sedation in young infants at Mzuzu Central Hospital, Malawi.
Methods
This retrospective case series included five young infants (aged 3-90 days) who underwent abdominal MRI under ketamine sedation between August 2025 and March 2026. Diagnoses included three cases of congenital biliary atresia, one cloacal exstrophy, and one sacrococcygeal teratoma. All patients initially failed non-pharmacological sedation using the feed-and-swaddle technique alone. Sedation was performed by an experienced anesthesiologist using intramuscular atropine (0.01 mg/kg) followed by ketamine (4-5 mg/kg). MRI scans were performed using a 1.5 T system. Respiratory status was assessed via MRI respiratory gating waveforms. Clinical data were collected from medical records, including anesthesia records, and analyzed descriptively.
Results
All MRI examinations were successfully completed, with a mean scan time of 23 minutes. No clinically significant adverse events were observed, including oxygen desaturation or airway-related complications. No overt clinical signs suggestive of hemodynamic instability were noted. All images were of diagnostic quality as assessed by the radiologist. The target sedation depth was achieved in all cases without the need for additional dosing. The mean time to emergence was 40 minutes, and the mean time to full recovery was 94 minutes, with no cases of delayed recovery or agitation.
Conclusion
Intramuscular ketamine, when used with appropriate precautions, appears to be a feasible option and may represent a safe alternative for MRI sedation in young infants in resource-limited settings.
Keywords: Young infant; Ketamine; Magnetic resonance imaging; Sedation; Resource-limited setting