The Evolving Role of Intranasal Dexmedetomidine for Pediatric Procedural Sedation.

Abstract

For decades, chloral hydrate (CH) was the standard agent used to provide sedation for noninvasive pediatric procedures.1 The drug had a long history of safe administration by nonanesthesia providers, which in many institutions included registered nurses.2,3 Despite reasonably high reported rates of success, CH had a number of disadvantages: a variable half-life in young children, clinical resedation, and a potential role as a neuroapoptotic agent in the developing brain.4,5 Perhaps the greatest disadvantage was the loss of the oral formulation in the US market, limiting its availability. After the loss of oral CH, many institutions evolved to an intravenous (IV) sedation regimen with propofol.6 Propofol was an attractive agent because of its high success rate, rapid onset, and short recovery. However, this change in practice presented new challenges because propofol is typically administered only by pediatric providers with advanced training in deep sedation or anesthesiologists. These deep sedation systems often require more intensive resource utilization (IV catheter placement, advanced monitoring systems, postanesthesia care, etc), which may have economic consequences for both the patient and the health care system. For many years, IV dexmedetomidine has been used for sedation in the critical care setting.7 In 2008, Mason et al8 took …