Intranasal administration of dexmedetomidine (DEX) as a premedication for pediatric patients undergoing general anesthesia for dental treatment

Abstract

BackgroundThe most important reason for pre-operative administration of medication is to reduce anxiety. Alleviation of fear and anxiety about surgery enables patients to remain comfortable during treatment. Dexmedetomidine (DEX) is a fast-acting drug that is used as a premedication in different circumstances because it has sedative and anti-anxiolytic effects, and stable hemodynamics. It also has the advantage of intranasal administration. The aim of this study was to investigate the effects and hemodynamic stability of DEX by retrospectively analyzing cases in which DEX was administered nasally as a premedication.MethodsTen patients treated at Dankook University Dental Hospital, recruited between February and April 2015, received intranasal delivery of 2 µg/kg DEX, 30 minutes prior to general anesthesia. Anesthesia records of anxiety, blood pressure, respiration, pulse, estimated arterial oxygen saturation (SpO2), and partial pressure, or maximum concentration, of carbon dioxide (ETCO2) were analyzed.ResultsAdministration of DEX prior to a general anesthetic effectively relieved anxiety. Respiratory depression, the most severe adverse effect of other sedatives, was not observed. Hemodynamic stability under general anesthesia was maintained during treatment and a reduction in emergence delirium was observed upon completion of treatment.ConclusionsPremedication administration of DEX is safe for pediatric patients undergoing dental treatment under general anesthesia.

Publication bias in pediatric emergence delirium: a cross-sectional analysis of ClinicalTrials.gov and ClinicalTrialsRegister.eu

“… 9 10 However, dexmedetomidine, like most potent sedatives, causes an unpleasant burning sensation when applied intranasally. 11 Oral application might therefore be a better choice for anxious children. One recent study showed that 1 µg/kg oral dexmedetomidine for premedication provided satisfactory sedation levels, but was not effective in preventing ED.…”

Silencing of long noncoding RNA MEG3 enhances cerebral protection of dexmedetomidine against hypoxic‐ischemic brain damage in neonatal mice by binding to miR‐129‐5p

“…11 Additionally, dexmedetomidine (DEX), a fastacting drug, is administered as a premedication in various situations due to its sedative and antianxiolytic effects and stable hemodynamics. 12 A series of findings have demonstrated that DEX could alleviate brain damage in neonatal rats following brain hypoxia-ischemia due to mediation of the α2 receptor to inhibit the inflammation in ischemic brain tissue. 13 Moreover, DEX exerts its protective effects during the treatment of cerebral ischemia and for recovering from hypoxia-ischemia-induced neuronal cell injury.…”

Unpublished clinical studies in pediatric emergence delirium – a cross sectional analysis

“…Two published studies could show a reduction of incidence and degree of ED following premedication with intranasal dexmedetomidine 9 10 . However, dexmedetomidine, like most potent sedatives, causes an unpleasant burning sensation when applied intranasally 11 . Oral application might therefore be a better choice for anxious children.…”