Effectiveness Of Intranasal Dexmedetomidine Research Articles

Challenge of using Intranasal dexmedetomidine as a premedication modality in pediatric patients: A meta-analysis of randomized controlled trials

ABSTRACT Background Intranasal dexmedetomidine premedication has been employed in children for controlling stress before induction of general anesthesia. Until now, the effect of intranasal dexmedetomidine in relation to other premeditations remains incompletely studied. Objectives This study was conducted to study the effectiveness and safety of intranasal dexmedetomidine premedication in pediatrics. Sittings Meta-analysis-based study following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Methods Systematic searches of the databases MEDLINE, EMBASE, PubMed, and Cochrane were conducted to collect all published randomized, controlled, clinical trials in the last seven years which compare the intranasal dexmedetomidine premedication with other methods of premedication in different procedures. Results Twenty-five studies were collected for inclusion in this research including 2601 patients. The bias risk was low. Meta-analysis showed that the use of dexmedetomidine intranasally as a premedication when compared with other premedication regimes results in significant evidence of decreasing emergence agitation (RR = 0.64 [0.54, 0.77] 95% CI; I2 = 84%; P = 0.0001) fewer sedation scores (Mean difference = 51 [0.38, 0.65]; 95% CI; I2 = 99%; P = 0.00001), significantly less incidence of postoperative nausea and vomiting ((RR = 0.30 [0.20, 0.45] 95% CI; I2 = 12%; P = 0.00001), significantly decreased BP ((Mean difference = -2.28 [−3.42, −1.14]; 95% CI; I2 = 88%; P = 0.0001), and significantly decreased heart rate and (mean difference = -6.67 [−8.37, −4.97]; 95% CI; I2 = 94%; P = 0.00001). Conclusion Intranasal dexmedetomidine provided a satisfactory level of emergence agitation, more satisfactory sedation, more hemodynamic stability, and reduced the incidence of postoperative complications in relation to other premeditations.

Intranasal dexmedetomidine with morphine or tramadol: A comparative study of effects on alfaxalone requirements for anesthesia in cats.

Intranasal (IN) sedatives provide a non-invasive route for premedication drug administration. This study compared the cardiorespiratory and sparing effects of IN dexmedetomidine combined with morphine (DM) or tramadol (DT) on alfaxalone requirements for anesthesia induction in cats. Twenty-four cats were randomly assigned to three groups: Dexmedetomidine combined morphine (IN dexmedetomidine 20 μg/kg plus 0.2 mg/kg morphine), DT (IN dexmedetomidine 20 μg/kg plus 1 mg/kg tramadol), or control (no premedication). The intravenous dose of 1% alfaxalone for endotracheal intubation was recorded with sedation scores, cardiorespiratory parameters (heart rate and respiration rate), and side effects. Both DM and DT were associated with significantly higher sedation scores than baseline, and sedation scores were found to be highest 20 min after premedication. Sedation scores were comparable between DM and DT groups. Side effects, including hypersalivation, vomiting, and pupillary dilation, were observed in the DM and DT groups. The dosage of alfaxalone required in the DM group (1.5 ± 0.3 mg/kg) was comparable to that of the DT group (2.0 ± 0.6 mg/kg, p = 0.0861), and both groups required significantly less alfaxalone than the control group (3.0 ± 0.6 mg/kg; p < 0.01). Heart and respiratory rates were comparable between the DM and DT groups. Duration of anesthesia in the control group (11 ± 4 min) was significantly shorter than in the DM (29 ± 5 min, p = 0.0016) and DT (38 ± 14 min, p < 0.001) groups. Intranasal administration of DM or DT produces good sedation and offers an alternative, non-invasive route for cats undergoing general anesthesia.

Safety and effectiveness of intranasal dexmedetomidine together with midazolam for sedation in neonatal MRI.

Magnetic resonance imaging (MRI) has been consistently indicated as the imaging modality of choice in children and neonates. MRI is pivotal for the management and prognostication of different neonatal conditions including neonatal encephalopathy, preterm birth and congenital heart diseases. While feed and wrap technique may be used to perform MRI scans without sedation, this is not always possible due to MRI sensitivity to motion artifacts and long duration of the procedure.

Effect of Intranasal Dexmedetomidine on Duration of Anesthesia and Postoperative Analgesia after Bupivacaine Caudal Epidural Anesthesia in Children Undergoing Infraumbilical Surgeries

Effect of Intranasal Dexmedetomidine on Duration of Anesthesia and Postoperative Analgesia after Bupivacaine Caudal Epidural Anesthesia in Children Undergoing Infraumbilical Surgeries

Comments on an article of EgJA in press.

Dear Editor of Egyptian Journal of Anaesthesia,I read an article, which was published on 18 March 2017, on the website of EgJA [1]. This was a study on the effects of intranasal dexmedetomidine in ...

Effect of intranasal dexmedetomidine on emergence agitation after sevoflurane anesthesia in children undergoing tonsillectomy and/or adenoidectomy.

Background:Emergence agitation (EA) after sevoflurane anesthesia is common in children during recovery from general anesthesia and may result in postoperative complications. This study investigated safety and effectiveness of intranasal dexmedetomidine in reducing the incidence and severity of EA.Methods:This prospective, randomized double-blinded controlled trial included 86 patients scheduled for the tonsillectomy and/or adenoidectomy under general anesthesia with sevoflurane. They were randomly allocated into two groups. Group D received intranasal dexmedetomidine at 1 μg/kg, and Group C received intranasal saline 0.9% after the induction of general anesthesia. Four-point agitation scale and Face, Legs, Activity, Cry and Consolability (FLACC) scale for pain assessment were measured at six time points (after extubation, leaving the operating room, on arrival to postanesthesia care unit [PACU], 10, 20, and 30 min after arrival in PACU). Extubation, emergence, and discharge times were recorded in addition to any adverse effects.Results:There was a significant difference in the incidence of EA between Groups D and C (6.98% and 58%, respectively, with P = 0.001). The median four-point agitation scales and the median scores of FLACC pain scales of Group D were significantly lower than those of Group C at the all six time points with P < 0.05. Extubation, emergence, and discharge times were comparable in both groups, and none of the subjects reported any adverse effects.Conclusion:This study demonstrates that a 1 μg/kg dose of intranasal dexmedetomidine administered after the induction of anesthesia reduces post-sevoflurane incidence and severity of EA in children undergone tonsillectomy and/or adenoidectomy with no adverse effects and smooth recovery profile.

Efficacy of Intranasal Dexmedetomidine for Conscious Sedation in Patients Undergoing Surgical Removal of Impacted Third Molar: A Double-Blind Split Mouth Study.

This study was conducted to evaluate the utility and effectiveness of Intranasal Dexmedetomidine on Sedation status and pain experience of the patients undergoing surgical extraction of impacted third molar. In this double-blind, split mouth study, in 15 patients, evaluations pertaining to classes of third molar impaction was done. Each patient was randomly assigned to receive either intranasal normal saline (placebo group) or intranasal 1.5µg/kg atomized Dexmedetomidine during the first session. The other regimen was used during the second session. Study was conducted for over a period of 120min and data for sedation and pain was collected at an interval of 30min. The collected data was then compared between the two groups within the same patient. Sedation status was assessed by a blinded observer with a modified Observer's Assessment of Alertness/Sedation (OAA/S) 13 scale (Annexure- B). Pain experience was evaluated by Visual Analog Scale (VAS) (Annexure-B). Clinical evaluation for sedation and pain was done by a blinded observer at 30, 60, 90, and 120min after administration of the intranasal solution. The values were then tabulated, and compared between two visits. The mean values of OAA score of Dexmedetomidine group were significantly higher as compared to Placebo group with a 'p' value of 0.000. And the mean values of Pain score of Dexmedetomidine group were significantly lower as compared to Placebo group with a 'p' value 0.009. The results of this study clearly indicated that: Intranasally administered Dexmedetomidine was significantly useful and effective to achieve optimal sedation and analgesia during third molar surgery.