Comparative Study of Intranasal Dexmedetomidine v/s Midazolam for Sedation of Pediatric Patients During Transthoracic Echocardiography

Abstract

Background: Procedural sedation required to improve the quality of Transthoracic Echocardiography (TTE) in infants and children. The ideal drug and route for sedation in children should have a rapid and reliable onset, atraumatic, palatable with minimal side effects, and rapid recovery. So, the aim of our study to evaluate and compare the efficacy and safety of intranasal midazolam and intranasal dexmedetomidine in pediatric patients for sedation during TTE. Materials and Method: Hundred children under three year of age, belonging to the American Society of Anaesthesiologists class-I and II, scheduled for TTE were divided into two groups by standard randomization technique. Patients in group-M received intranasal midazolam 0.2 mg/kg, whereas patients in group-D received intranasal dexmedetomidine 2 μg/kg prior to TTE under an adequately monitored anesthesia care. Onset and duration of sedation, heart rate, oxygen saturation, sonographer's, and parent's satisfaction scores were recorded. Results: All patients were successfully sedated for TTE. The average onset time, sedation time, awakening time and total time for Group-M were 7.3, 18.8, 29.51, 51 min and group-D were 10.1, 14.2, 24.9, 46.3 min, respectively and all were statistically significant (P < 0.001). TTE scan time of Group-M is 8.84 min and Group-D is 9.18 min and was statistically significant. Sonographer's and Parent's average satisfaction score for Group-M was 9.88, 10 and for Group-D was 7.64, 8.76, respectively, which were statistically significant (P < 0.001). Conclusion: Intranasal midazolam and dexmedetomidine are safe and effective for sedation in TTE. Intranasal midazolam was found to be comparatively more effective in view of onset of action, sonographers, and parental satisfaction score, while sedation time, awakening time and total duration was significantly higher as compared to intranasal dexmedetomidine.

Intranasal dexmedetomidine for transthoracic echocardiography in infants with shunt-dependent single ventricle heart disease

“…[17][18] Intranasal dexmedetomidine, intranasal ketamine, oral chloral hydrate, and intranasal midazolam have been described as perhaps more suitable options. 9,12,[14][15][16]18 Dexmedetomidine is a highly selective alpha-2 agonist that provides anxiolysis, mild analgesia, and cooperative sedation without respiratory depression. 19 It decreases central nervous system sympathetic outflow in a dose-dependent manner and can be administered intranasally for procedural sedation which is ideal when attempts to minimise traumatic administration via intravenous or intramuscular routes are taken into consideration.…”

“…Midazolam, a benzodiazepine, is the most commonly studied procedural sedation drug and can be administered either intranasally or orally; however, it provides no analgesia and is associated with adverse events such as post-operative behavioural changes, cognitive impairment, paradoxical reactions, and respiratory depression. 9,16 Additionally, intranasal midazolam is known to provide nasal irritation and burning. 28 On the contrary, intranasal ketamine is used for its pain controlling aspect and may provide less bradycardia than dexmedetomidine but is not devoid of adverse events such as gastrointestinal tract stimulation, excessive salivation, nystagmus, an increased incidence of emergence agitation, and an unpleasant bitter taste.…”

“…17–18 Intranasal dexmedetomidine, intranasal ketamine, oral chloral hydrate, and intranasal midazolam have been described as perhaps more suitable options. 9,12,14–16,18…”

“…[9][10][11][12] Intranasal dexmedetomidine use for echocardiographic sedation has emerged as perhaps the most attractive option as it is widely available, easy to administer, safe and efficacious with minimal adverse events. 4,[9][10][11][12][13][14][15][16] Despite its potential utility in paediatric procedural sedation, no published reviews have examined intranasal dexmedetomidine administration in patients with shunt-dependent single ventricle heart disease who may be more vulnerable to changes in afterload and heart rate. A determination of a safe and effective sedation regimen in this patient population would be most beneficial as the haemodynamic effects of a procedural sedation regimen would be most pronounced.…”

Comparison of nebulized ropivacaine (0.75%) with nebulized dexmedetomidine on the hemodynamic response on intubation in patients undergoing surgery under general anesthesia: A comparative randomized double-blind placebo-controlled study

“…[ 8 ] It has been widely used as a premedication in pediatric patients for procedural sedation and premedication, where it has shown promising results. [ 9 10 11 12 ] Hussain et al have reported in the literature that dexmedetomidine when administered through the nebulization route had reduced stress response to laryngoscopy and intubation. [ 13 ] Thomas D et al also reported that nebulized dexmedetomidine can attenuate the postoperative sore throat in patients.…”