Dexmedetomidine For Sedation In Children Research Articles

Effect of Intranasal Dexmedetomidine or Midazolam for Premedication on the Occurrence of Respiratory Adverse Events in Children Undergoing Tonsillectomy and Adenoidectomy

Perioperative respiratory adverse events (PRAEs) are the most common complication during pediatric anesthesia, and they may be affected by the administration of preoperative sedatives. To investigate the effect of intranasal dexmedetomidine or midazolam used for premedication on the occurrence of PRAEs. This single-center, double-blind, randomized clinical trial was conducted among children aged 0 to 12 years undergoing elective tonsillectomy and adenoidectomy from October 2020 to June 2021 at Children's Hospital of Xuzhou Medical University, Xuzhou, China. Data analysis was performed from June to October 2021. Children were randomly assigned to 3 groups: the midazolam group received intranasal midazolam (0.1 mg/kg), and the dexmedetomidine group received intranasal dexmedetomidine (2.0 μg/kg) for premedication. The normal saline group received intranasal 0.9% saline for control. The primary outcome was the difference in the incidence of PRAEs among the 3 groups. The secondary outcomes were the frequency of the individual PRAEs, including the incidence of such events during the induction and recovery periods, postoperative emergence delirium, postoperative pain score, sedation success rate, and heart rate values. A total of 384 children (median [IQR] age, 7 [5-10] years; 227 boys [59.1%]) were enrolled and randomized; 373 data sets were available for intention-to-treat analysis (124 children in the midazolam group, 124 children in the dexmedetomidine group, and 125 children in the normal saline group). After the data were adjusted for age, sex, American Society of Anesthesiologists physical status, body mass index, obstructive sleep apnea, upper respiratory tract infection, and passive smoking, children in the midazolam group were more likely to experience PRAEs than those in the normal saline group (70 of 124 children [56.5%] vs 51 of 125 children [40.8%]; adjusted odds ratio [aOR], 1.99; 95% CI, 1.18-3.35), whereas the dexmedetomidine group had a significantly lower PRAEs incidence than the normal saline group (30 of 124 children [24.2%] vs 51 of 125 children [40.8%]; aOR, 0.45; 95% CI, 0.26-0.78). Compared with the dexmedetomidine group, the midazolam group had a higher risk of PRAEs (aOR, 4.44; 95% CI, 2.54-7.76), but no other serious clinical adverse events were observed. In this randomized clinical trial, intranasal midazolam used for premedication was associated with increased incidence of PRAEs, whereas premedication with intranasal dexmedetomidine was associated with reduced incidence of PRAEs. Where clinically appropriate, anesthesiologists should consider using intranasal dexmedetomidine for sedation in children undergoing tonsillectomy and adenoidectomy. Chinese Clinical Trial Register Identifier: ChiCTR2000038359.

Intranasal dexmedetomidine is an effective sedative agent for electroencephalography in children

BackgroundIntranasal dexmedetomidine (DEX), as a novel sedation method, has been used in many clinical examinations of infants and children. However, the safety and efficacy of this method for electroencephalography (EEG) in children is limited. In this study, we performed a large-scale clinical case analysis of patients who received this sedation method. The purpose of this study was to evaluate the safety and efficacy of intranasal DEX for sedation in children during EEG.MethodsThis was a retrospective study. The inclusion criteria were children who underwent EEG from October 2016 to October 2018 at the Children’s Hospital affiliated with Chongqing Medical University. All the children received 2.5 μg·kg− 1 of intranasal DEX for sedation during the procedure. We used the Modified Observer Assessment of Alertness/Sedation Scale (MOAA/S) and the Modified Aldrete score (MAS) to evaluate the effects of the treatment on sedation and resuscitation. The sex, age, weight, American Society of Anesthesiologists physical status (ASAPS), vital signs, sedation onset and recovery times, sedation success rate, and adverse patient events were recorded.ResultsA total of 3475 cases were collected and analysed in this study. The success rate of the initial dose was 87.0% (3024/3475 cases), and the success rate of intranasal sedation rescue was 60.8% (274/451 cases). The median sedation onset time was 19 mins (IQR: 17–22 min), and the sedation recovery time was 41 mins (IQR: 36–47 min). The total incidence of adverse events was 0.95% (33/3475 cases), and no serious adverse events occurred.ConclusionsIntranasal DEX (2.5 μg·kg− 1) can be safely and effectively used for EEG sedation in children.

To Compare the Efficacy of Two Intravenous Combinations of Drugs Ketamine-Propofol vs Ketamine-Dexmedetomidine for Sedation in Children Undergoing Dental Treatment.

ObjectiveTo compare the efficacy of two intravenous combinations of drugs ketamine–propofol (KP) vs ketamine–dexmedetomidine (KD) for sedation in children undergoing dental treatment.Study designThirty patients were selected, evaluated according to the predetermined criteria and divided in equal numbers of 15 amongst 2 groups KP and KD.Materials and methodsInformed consent was taken, nil per oral (NPO) guidelines were followed and the study drug was administered. Dental procedure was performed. Heart rate (HR), blood pressure (BP) and oxygen saturation (SPO2) were monitored continuously throughout the procedure. The modified Ramsay sedation (MRS) score was recorded along with Houpt sedation score. Recovery status was accessed by modified Aldrete's recovery scale.Statistical analysisStudent t test was used for comparing HR, BP and SPO2. Chi-square test was used to compare MRS, Houpt sedation score and modified Aldrete's recovery scale amongst the two groups KP and KD.ResultsThe sedation achieved with both the groups was adequate. Both the drugs produce adequate hemodynamic stability.ConclusionKetamine–dexmedetomidine has a better efficacy over the other group, ketamine–propofol.How to cite this articleJoshi AB, Shankaranarayan UR, Hegde A, et al. To Compare the Efficacy of Two Intravenous Combinations of Drugs Ketamine–Propofol vs Ketamine–Dexmedetomidine for Sedation in Children Undergoing Dental Treatment. Int J Clin Pediatr Dent 2020;13(5):529–535.

Comment on: “Intranasal Dexmedetomidine for Procedural Sedation in Children, a Suitable Alternative to Chloral Hydrate”

Comment on: “Intranasal Dexmedetomidine for Procedural Sedation in Children, a Suitable Alternative to Chloral Hydrate”

A comparison of intranasal dexmedetomidine for sedation in children administered either by atomiser or by drops

Intranasal dexmedetomidine has been used successfully for sedation in children. A mucosal atomisation device delivers an atomised solution to the nasal mucosa which facilitates rapid and effective delivery of medication to the systemic circulation. We compared intranasal delivery of dexmedetomidine in a dose of 3 μg.kg(-1) by either atomiser or drops from a syringe in children < 3 years old undergoing transthoracic echocardiography. Two hundred and seventy-nine children were randomly assigned to one or other group. One hundred and thirty-seven children received dexmedetomidine by atomiser and 142 by drops. The successful sedation rate was 82.5% (95% CI 75.3-87.9%) and 84.5% (95% CI 77.7-89.5%) for atomiser and drops, respectively (p = 0.569). Sedation tended to be less successful in older children (p = 0.028, OR 0.949, 95% CI 0.916-0.983). There were no significant complications. We conclude that both modes of dexmedetomidine administration are equally effective, although increasing age of the child was associated with a decreased likelihood of successful sedation.

Intranasal dexmedetomidine for sedation in children undergoing transthoracic echocardiography study--a prospective observational study.

Intranasal dexmedetomidine has been used for sedation in children undergoing nonpainful procedures. The aim of this study was to determine the success rate of intranasal dexmedetomidine sedation for children undergoing transthoracic echocardiography examination. This was a prospective observational study of 115 children under the age of 3 years undergoing echocardiography examination under sedation with intranasal dexmedetomidine at 3 mcg·kg(-1). Of the 115 children, 100 (87%) had satisfactory sedation with intranasal dexmedetomidine. The mean onset time was 16.7 ± 7 min (range 5-50 min). The mean wake up time was 44.3 ± 15.1 min (range 12-123 min). The wake up time was significantly correlated with duration of procedure with R = 0.540 (P < 0.001). Aside from one patient who required oxygen supplementation, all children in this investigation had an acceptable heart rate and blood pressure and required no medical intervention. Sedation by intranasal dexmedetomidine at 3 mcg·kg(-1) is associated with acceptable success rate in children undergoing echocardiography with no adverse events in this cohort.

Intramuscular Dexmedetomidine Sedation for Pediatric MRI and CT: Mason KP, Lubisch NB, Robinson F, et al. AJR Am J Roentgenol 2011;197:720–5.

Sedation in pediatrics continues to be an area of great interest among researchers, as clinicians try to balance adequate sedation, side-effect profiles, and less painful administration of pharmacologic agents. In this retrospective chart review, researchers examined the efficacy of intramuscular (IM) dexmedetomidine for sedation in children undergoing diagnostic imaging, as well as assessing the safety of the agent in the same population. Sixty-five children from age 1 month to 10 years, with the majority being 2–3 years of age, undergoing magnetic resonance imaging or computed tomography scans for non-traumatic indications received dexmedetomidine for sedation.

Dexmedetomidine for Sedation in Children with Neurobehavioral Disorders

Translations: Abstracts from the 15th Annual Pediatric Critical Care Colloquium: Oral Abstract Presentations