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

Li, Bl L.; Zhang, N.; Huang, Jx X.; Qiu, Qinwei; Tian, Heshen; Ni, Jiajia; Song, Xr R.; Yuen, Vincent Wai‐Hin; Irwin, Michael G.

doi:10.1111/anae.13407

Cited by 64 publications

(55 citation statements)

References 20 publications

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“…17 The incidence of respiratory depression or adverse respiratory events with intranasal dexmedetomidine for procedural sedation was very low. 3,4,7 Although bradycardia and hypotension was more common side effects, intervention was rarely required.…”

Section: Discussionmentioning

confidence: 99%

“…Oral chloral hydrate is the most commonly used sedative in children for ABR test; 1 intranasal dexmedetomidine is used increasingly for other non-painful procedural sedation. [2][3][4][5][6] The successful sedation rate of intranasal dexmedetomidine was similar to oral chloral hydrate for computer tomography studies, but intranasal dexmedetomidine was associated with better behavior and less gastrointestinal side effects. 7 While CT studies are short and nonstimulating, ABR tests lasts longer and are more stimulating.…”

Section: Introductionmentioning

confidence: 99%

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A randomized controlled trial of oral chloral hydrate vs intranasal dexmedetomidine plus buccal midazolam for auditory brainstem response testing in children

Yuen

Zhou

et al. 2018

Pediatric Anesthesia

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Summary Background Moderate to deep sedation is required for an auditory brainstem response test when high‐intensity stimulation is used. Chloral hydrate is the most commonly used sedative, whereas intranasal dexmedetomidine is increasingly used in pediatric non‐painful procedural sedations. Objective The aim of this study was to compare the sedation success rate after oral chloral hydrate at 50 mg kg−1 and intranasal dexmedetomidine at 3 μg kg−1 plus buccal midazolam at 0.1 mg kg−1 for an auditory brainstem response test. Methods Children who required an auditory brainstem response test were recruited and randomly assigned to receive oral chloral hydrate at 50 mg kg−1 and intranasal placebo, or intranasal dexmedetomidine at 3 μg kg−1 with buccal midazolam 0.1 mg kg−1. The primary outcome was the rate of successful sedation for auditory brainstem response tests. Results Fifty‐seven out of 82 (69.5%) were successfully sedated after chloral hydrate, while 70 out of 78 (89.7%) children were successfully sedated with dexmedetomidine plus midazolam combination, with the odd ratio (95% CI) for successful sedation between dexmedetomidine plus midazolam combination and chloral hydrate estimated to be 3.84 (1.61‐9.16), P = 0.002. Dexmedetomidine plus midazolam was associated with quicker onset with median onset time 15 (IQR 11.0‐19.8) for dexmedetomidine plus midazolam and 20 (IQR 15.0‐27.0) for chloral hydrate respectively, with difference between median (95% CI) of 5 [3‐8], P < 0.0001). The behavior observed during drug administration of intranasal dexmedetomidine and buccal midazolam was better that of the children who had oral chloral hydrate. No children required oxygen therapy or medical intervention for hemodynamic disturbances in this study and the incidence of hypotension and bradycardia was similar. Conclusion Intranasal dexmedetomidine plus buccal midazolam was associated with higher sedation success with deeper level of sedation, with similar discharge time and adverse event rate when compared to chloral hydrate.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A randomized controlled trial of oral chloral hydrate vs intranasal dexmedetomidine plus buccal midazolam for auditory brainstem response testing in children

Yuen

Zhou

et al. 2018

Pediatric Anesthesia

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“…Dexmedetomidine is well absorbed through the intranasal and buccal mucosae, a feature that could be of benefit when using dexmedetomidine in uncooperative children or geriatric patients (Sect. 9) [15–18]. …”

Section: Pharmacokineticsmentioning

confidence: 99%

“…It can be useful for sedation and premedication in pediatric subjects [18, 118–120]. After an intranasal dose of 84 µg dexmedetomidine in healthy volunteers, a lag time of 2–3 min was described and the time to maximum plasma concentration was reached 38 min after administration.…”

Section: New Clinical Applicationsmentioning

confidence: 99%

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Clinical Pharmacokinetics and Pharmacodynamics of Dexmedetomidine

et al. 2017

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Dexmedetomidine is an α2-adrenoceptor agonist with sedative, anxiolytic, sympatholytic, and analgesic-sparing effects, and minimal depression of respiratory function. It is potent and highly selective for α2-receptors with an α2:α1 ratio of 1620:1. Hemodynamic effects, which include transient hypertension, bradycardia, and hypotension, result from the drug’s peripheral vasoconstrictive and sympatholytic properties. Dexmedetomidine exerts its hypnotic action through activation of central pre- and postsynaptic α2-receptors in the locus coeruleus, thereby inducting a state of unconsciousness similar to natural sleep, with the unique aspect that patients remain easily rousable and cooperative. Dexmedetomidine is rapidly distributed and is mainly hepatically metabolized into inactive metabolites by glucuronidation and hydroxylation. A high inter-individual variability in dexmedetomidine pharmacokinetics has been described, especially in the intensive care unit population. In recent years, multiple pharmacokinetic non-compartmental analyses as well as population pharmacokinetic studies have been performed. Body size, hepatic impairment, and presumably plasma albumin and cardiac output have a significant impact on dexmedetomidine pharmacokinetics. Results regarding other covariates remain inconclusive and warrant further research. Although initially approved for intravenous use for up to 24 h in the adult intensive care unit population only, applications of dexmedetomidine in clinical practice have been widened over the past few years. Procedural sedation with dexmedetomidine was additionally approved by the US Food and Drug Administration in 2003 and dexmedetomidine has appeared useful in multiple off-label applications such as pediatric sedation, intranasal or buccal administration, and use as an adjuvant to local analgesia techniques.

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Dexmedetomidine for analgesia and sedation in newborn infants receiving mechanical ventilation

Lim,

Ker,

Lai

et al. 2024

Cochrane Database of Systematic Reviews

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

Cited by 64 publications

References 20 publications

A randomized controlled trial of oral chloral hydrate vs intranasal dexmedetomidine plus buccal midazolam for auditory brainstem response testing in children

A randomized controlled trial of oral chloral hydrate vs intranasal dexmedetomidine plus buccal midazolam for auditory brainstem response testing in children

Clinical Pharmacokinetics and Pharmacodynamics of Dexmedetomidine

Dexmedetomidine for analgesia and sedation in newborn infants receiving mechanical ventilation

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