Intranasal dexmedetomidine for paediatric sedation for diagnostic magnetic resonance imaging studies

Ambi, Uday; Joshi, Chhaya; Ganeshnavar, Anilkumar; Adarsh, ES

doi:10.4103/0019-5049.104588

Cited by 38 publications

(41 citation statements)

References 7 publications

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“…Numerous published studies found no adverse respiratory events associated with the use of intranasal dexmedetomidine and/or ketamine . Rate of respiratory events observed in this study is similar.…”

Section: Discussionsupporting

confidence: 84%

“…Dexmedetomidine is useful as a sedative/hypnotic, and offers the advantage of having both sedative and anxiolytic effects, as well as relatively mild analgesic properties and a relatively short elimination half‐life of 2 h . Dexmedetomidine has been useful by the intranasal route, but has some drawbacks in terms of effectiveness, onset and offset time.…”

Section: Introductionmentioning

confidence: 99%

“…and a relatively short elimination half-life of 2 h. 5 Dexmedetomidine has been useful by the intranasal route, [6][7][8][9][10] but has some drawbacks in terms of effectiveness, onset and offset time.…”

mentioning

confidence: 99%

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Analysis of 17 948 pediatric patients undergoing procedural sedation with a combination of intranasal dexmedetomidine and ketamine

Yang

Liu

et al. 2018

Pediatric Anesthesia

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Summary Background Intranasal procedural sedation using dexmedetomidine is well described in the literature. The combination of intranasal dexmedetomidine and ketamine is a novel approach for which there are little data on the rate of successful sedation or adverse events. Objectives The aim of this study is to evaluate the rate of successful sedation and adverse events of intranasal procedural sedation using a combination of dexmedetomidine and ketamine for diagnostic examination in children. Methods This was a retrospective study and data were collected after ethics approval. A total of 17 948 pediatric patients (7718 females, 10 230 males) in a tertiary hospital in China were evaluated. Patients received a combination of 2 μg kg−1 of dexmedetomidine and 1 mg kg−1 of ketamine intranasally for procedural sedation. The level of sedation and recovery was assessed by the Modified Observer Assessment of Alertness/Sedation scale and the Modified Aldrete Score. Results The rate of intranasal sedation success was 93% (16691/17948), intranasal sedation rescue was 1.8% (322/17948), and intranasal sedation failure was 5.2% (935/17948). Sedation success was defined as successful completed the diagnostic examination and obtained adequate diagnostic‐quality images and reports. Intranasal sedation success, rescue and failure were respectively defined as sedation success with intranasal a single dose, additional bolus dose and the need for intravenous (IV) medications/inhalation agents. Median sedation time was 62 min (interquartile range: 55‐70 min), median time for onset of sedation was 15 min (interquartile range: 15‐20 min), and median sedation recovery time was 45 min (interquartile range: 38‐53 min). Incidence of adverse events was low (0.58%; 105/17948), with major and minor adverse event being reported in 0.02% (4/17948) and 0.56% (101/17948) patients, respectively. Postoperative nausea and vomiting was the most common (0.3%; 53/17948) minor adverse event. Conclusion Procedural sedation using a combination of intranasal dexmedetomidine and ketamine is associated with acceptable effectiveness and low rates of adverse events.

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Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

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Analysis of 17 948 pediatric patients undergoing procedural sedation with a combination of intranasal dexmedetomidine and ketamine

Yang

Liu

et al. 2018

Pediatric Anesthesia

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“…This combination of sedatives is non‐parenteral, convenient to administer and well tolerated by children. When intranasal dexmedetomidine was used for non‐painful procedure with long duration and more intense stimulation such as magnetic resonance imaging studies, the success rate was low . The combination of dexmedetomidine and midazolam may be tested in this procedure.…”

Section: Discussionmentioning

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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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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“…Sir–Intranasal dexmedetomidine has been studied for procedural sedation in children. Nevertheless, its use for pediatric magnetic resonance imaging (MRI) seems unsatisfactory with studies showing a procedural success rate of 60% and 70%, without the need of a sedative rescue treatment …”

mentioning

confidence: 99%

Combination of intranasal dexmedetomidine and oral midazolam as sedation for pediatric MRI

Cozzi

Monasta

Maximova

et al. 2017

Pediatric Anesthesia

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Intranasal dexmedetomidine for paediatric sedation for diagnostic magnetic resonance imaging studies

Cited by 38 publications

References 7 publications

Analysis of 17 948 pediatric patients undergoing procedural sedation with a combination of intranasal dexmedetomidine and ketamine

Analysis of 17 948 pediatric patients undergoing procedural sedation with a combination of intranasal dexmedetomidine and ketamine

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

Combination of intranasal dexmedetomidine and oral midazolam as sedation for pediatric MRI

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