Aim This systematic review and meta‐analysis evaluated the effectiveness of intranasal dexmedetomidine as a sole sedative during paediatric procedural sedation outside the operating room. Methods Relevant literature identified by PubMed, Scopus, ClinicalTrials.gov, ScienceDirect and Cochrane Library up to 31 December 2019 was systematically reviewed. Randomised controlled trials that compared intranasal dexmedetomidine with another sedative or placebo during paediatric procedural sedation were included. Trials that studied intranasal dexmedetomidine as a premedication before anaesthesia were excluded. The primary outcome was the success of the planned procedure. Results We analysed seven randomised controlled trials of 730 patients: four trials with 570 patients compared dexmedetomidine with chloral hydrate and three trials with 160 patients compared dexmedetomidine with midazolam. The incidence of successfully completing the procedure did not differ between dexmedetomidine and chloral hydrate, but dexmedetomidine had a higher success rate than midazolam. The incidence of hypotension, bradycardia or respiratory complications did not differ between the sedatives used. Nausea and vomiting were more common in children treated with chloral hydrate than in those treated with other sedatives. Conclusion Intranasal dexmedetomidine was a safe and effective sedative for minor paediatric procedures.

Paediatric procedures requiring sedation are increasingly being performed off site, but there are no national guidelines for paediatric procedural sedation in Finland or studies on it. Therefore, the aim of this survey was to assess national practices for paediatric procedural sedation outside operation rooms and intensive care units in terms of indications, sedative medication, treatment facilities, patient safety and training of the personnel. An online survey including single‐ and multiple‐choice questions and open‐ended questions was sent to Finnish paediatricians, paediatric surgeons and paediatric anaesthesiologists via the electronic mailing lists of national societies in December 2019. A total of 71 responses were received. Lumbar puncture (41%), intra‐articular injections (38%) and MRI (17%) were the most common procedures that required routine sedation. Benzodiazepines were the most frequently used sedatives during both painful procedures (80%) and imaging (61%). Pulse oximetry monitoring was reported by 75% of the respondents, but other physiological parameters were rarely monitored (ECG 28%; blood pressure 39%; respiratory rate 34%). The level of sedation was not objectively assessed. Adrenaline (72%) and equipment for managing adverse respiratory outcomes (supplemental oxygen 98%; ventilation equipment 92%) were available in most facilities in which sedation was performed. Only one‐third of the respondents had undergone training for paediatric procedural sedation, and only 39% of the hospital units compiled statistical data on sedation‐related adverse events. The paediatric procedural sedation practices vary across hospitals. National guidelines for patient monitoring and training of personnel could improve treatment quality and patient safety.

Objective: To evaluate the effectiveness of intranasal dexmedetomidine as a sole sedative during pediatric procedural sedation.Design: Systematic review and meta-analysis.

Our was limited due to the lack of a control group. Further, 73% of the patients were new asthmatic patients, and thus, our results may not comply with difficult-to-treat asthma. Although our study provided valuable information on the use of dexmedetomidine in a real-life setting, it is considered preliminary, and larger, randomised controlled trials are needed.In conclusion, the use of dexmedetomidine in paediatric nearfatal asthma did not appear to have any significant side effects even among toddlers. Adding low-dose dexmedetomidine to continuous salbutamol inhalation might improve tolerance to nebulised beta 2agonists and enhance their therapeutic effect.