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A typical systematic review takes 6 to 18 months and over 1,000 hours of manual work. Teams read thousands of abstracts one by one, copy numbers into spreadsheets by hand, and redo the process when new studies publish. Most of the labor is mechanical. The judgment calls — what to include, how to rate bias, whether the evidence holds — those are the parts that matter.
Background: Pediatric MRI frequently requires sedation to minimize motion artifacts. Comparative data on sedation protocols remain limited. Methods: Multicenter RCT comparing propofol (n=84), sevoflurane (n=81), and dexmedetomidine (n=79) in children aged 1 to 7 years. Primary outcomes were image quality and time to discharge. Results: Image quality adequate in 96% propofol, 91% sevoflurane, 94% dexmedetomidine. Emergence agitation: 2.4% vs 14.8% vs 1.3% (P<0.001).
| Arm | n | Image Quality (%) | Discharge (min) | Agitation (%) | Risk of Bias |
|---|---|---|---|---|---|
| Propofol | 84 | 96.4 | 38 (28–52) | 2.4 | Low |
| Sevoflurane | 81 | 91.4 | 51 (38–67) | 14.8 | Some concerns |
| Dexmedetomidine | 79 | 94.3 | 62 (45–78) | 1.3 | Low |
| Outcome | Studies | Participants | Effect (95% CI) | Certainty |
|---|---|---|---|---|
| Time to discharge | 5 | 487 | MD -12.6 min [-16.1, -9.1] | High |
| Image quality (adequate) | 4 | 402 | RR 1.05 [0.99, 1.11] | Moderate |
| Emergence agitation | 5 | 487 | RR 0.16 [0.06, 0.43] | High |
| Serious adverse events | 3 | 310 | RD 0.00 [-0.02, 0.02] | Low |
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