Comparing sedative effect of dexmedetomidine versus midazolam for sedation of children while undergoing computerized tomography imaging

Abstract

A BSTRACT Background: Pediatric anxiety and restlessness may create issues and difficulties in performing accurate diagnostic studies even noninvasive ones, such as radiological imaging. There are some agents that will help to get this goal. This study aimed to compare the intranasal effect of dexmedetomidine (DEX) and midazolam (MID) for sedation parameters of children undergoing computerized tomography (CT) imaging. Materials and Methods: A double-blind clinical trial was conducted on 162 eligible children who underwent CT imaging. These patients were divided into two groups including MID ( n = 81) with dose of 0.3 mg.kg and DEX ( n = 81) with dose of 3 μg.kg, which was consumed intranasally. The mean blood pressure (MBP), respiratory rate (RR), heart rate (HR), and oxygen saturation (O2Sat) in children were recorded. Then, time of initiation, level of sedation, and duration effect of medication were measured at 0, 10, 20, and 30 min. Parents and clinician satisfaction score was asked. All data were analyzed using the Statistical Package for the Social Sciences (SPSS) software by t test and chi-square test. Results: Decreasing in MBP and HR was higher in DEX group than MID group ( P < 0.001), whereas decrease of O2Sat in MID group was higher than DEX group (0.009). Starting time of sedation (22.72 ± 11.64 vs. 33.38 ± 10.17, P = 0.001) was lower in DEX group. Parents ( P < 0.001) and physician ( P < 0.001) satisfaction score was higher in DEX group than the MID group. Conclusion: Using 3 μg/kg intranasal DEX for sedation of 1–6-year-old children was a suitable method to undergo noninvasive studies such as CT imaging. Intranasal DEX is superior to MID due to higher sedation satisfactory, faster starting effect of sedation, and lower side effects and complications. Nevertheless, in children with hemodynamic instability DEX is not an appropriate choice.

The use of dexmedetomidine in the emergency department: A systematic review

“…Two RCTs, 35,41 four cohort studies and other nonrandomized studies, 21,42,44,45 and one case series 52 reported the use of DEX specifically for sedation to facilitate radiologic imaging, generally in children. As above, pooling of efficacy results was not feasible.…”

“…Study designs included 11 RCTs, 22,[32][33][34][35][36][37][38][39][40][41] 13 cohort studies and other nonrandomized studies, [19][20][21]23,[42][43][44][45][46][47][48][49][50] and 11 case series and case reports. 12,[51][52][53][54][55][56][57][58][59][60] Six of the included studies were conference abstracts.…”

Dexmedetomidine for patients with croup

“…Dexmedetomidine is a newer sedative drug that is a selective α 2 agonist and acts as a central agent in the brain and spinal cord [ 13 ]. One of the most important advantages of dexmedetomidine is its low potential for respiratory depression.…”

“…It has little effect on the structure of the upper respiratory tract [ 14 ]. Therefore, dexmedetomidine is preferred over other sedatives in patients at high risk of upper airway obstruction, such as those with a history of obstructive sleep apnea [ 13 , 14 ]. For these reasons, we believe that dexmedetomidine is the safest and most suitable sedative for patients with croup.…”

Comparison of the effects of dexmedetomidine and propofol in reducing recovery agitation in pediatric patients after ketamine procedural sedation in emergency department

“…Dex is a potent α2-adrenergic agonist, used to induce sedation, reduce the dose of anesthetic agent, and improve hemodynamic stability, which suggests that it can be a suitable adjuvant to ketamine anesthesia. [ 11 ] Propofol is a sedative-hypnotic agent with rapid onset and short duration of action. It has been proposed that propofol can reduce the incidence of emergence agitation.…”