Premedication with intranasal dexmedetomidine decreases barbiturate requirement in pediatric patients sedated for magnetic resonance imaging: a retrospective study

Abstract

Background: Barbiturates are commonly used in ambulatory sedation of pediatric patients. However, use of barbiturates involve risks of respiratory complications. Dexmedetomidine, a highly selective α2-adrenoceptor agonist, is increasingly used for pediatric sedation. Premedication with intranasal (IN) dexmedetomidine offers a non-invasive and efficient possibility to sedate pediatric patients undergoing magnetic resonance imaging (MRI). Our hypothesis was that dexmedetomidine would reduce barbiturate requirements in procedural sedation. Methods: We included 200 consecutive pediatric patients undergoing MRI, and analyzed their hospital records retrospectively. Half of the patients received 3 μg/kg of IN dexmedetomidine (DEX group) 45-60 min before MRI while the rest received only thiopental (THIO group) for procedural sedation. Sedation was maintained with further intravenous thiopental dosing as needed. Thiopental consumption, heart rate (HR) and peripheral oxygen saturation were recorded. Results: The cumulative thiopental requirement during MRI was (median and interquartile range [IQR]) 4.4 (2.7-6.0) mg/kg/h in the DEX group and 12.4 (9.8-14.8) mg/kg/h in the THIO group (difference 7.9 mg/kg/h, 95% CI 6.8–8.8, P < 0.001). Lowest measured peripheral oxygen saturation remained slightly higher in the DEX group compared to the THIO group (median nadirs and IQR: 97 (95-97) % and 96 (94-97) %, P < 0.001). Supplemental oxygen was delivered to 33 % of the patients in the THIO group compared to 2 % in the DEX group (P < 0.001). The lowest measured HR (mean and SD) was lower (78 (16) bpm) in the DEX group compared to the THIO group (92 (12) bpm) (P < 0.001). Conclusion: Premedication with IN dexmedetomidine (3 μg/kg) was associated with markedly reduced thiopental dosage needed for efficient procedural sedation for pediatric MRI.

Drug selection for sedation in magnetic resonance imaging

“…Dexmedetomidine decreased the amount of thiopental required to sedate people. 13 Results of a retrospective review stated that in 78.5% of paediatric cases, high doses of dexmedetomidine were successful; for 21.5% of patients, additional drugs were necessary. About 25% of cases had side effects, which went away on their own.…”

Multicenter Randomized Controlled Trial comparing Oral Chloral Hydrate and Intranasal combination of Dexmedetomidine and Ketamine for Procedural Sedation in Children: study protocol

“…[37,38] Intranasal dexmedetomidine can induce sedation within 30 min in pediatric patients. [2, 5, 6, 9, 11, 12, 14-22, 24, 26-28, 31,35,36,38,39] A recent study reported that intranasal dexmedetomidine 4 μg/kg enabled magnetic resonance imaging (MRI) examination without apnea and hypoxemia in infants; [27] however, 30.7% (16/52) of the patients developed bradycardia (<80% of the baseline heart rate), and 3.8% (2/52) developed hypotension (<80% of the baseline mean arterial pressure). As such, intranasal dexmedetomidine alone can be associated with slow onset time, bradycardia, or hypotension.…”