Sedation effects of intranasal dexmedetomidine combined with ketamine and risk factors for sedation failure in young children during transthoracic echocardiography

Liu, Jianxia; Du, Min; Liu, Lu; Cao, Fei; Xu, Ying

doi:10.1111/pan.13529

Cited by 17 publications

(12 citation statements)

References 26 publications

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“…A previous study revealed that the success rate of dexmedetomidine sedation varied with age, weight and disease ( 30 ). In the current study, we have shown that history of sedation failure was the only risk factor contributing to sedation failure and this finding was consistent with Liu’s study on intranasal dexmedetomidine–ketamine combination ( 31 ).…”

Section: Discussionsupporting

confidence: 92%

Using intranasal dexmedetomidine with buccal midazolam for magnetic resonance imaging sedation in children: A single-arm prospective interventional study

Luo

Huang

et al. 2022

Front. Pediatr.

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ObjectiveAlthough numerous intravenous sedative regimens have been documented, the ideal non-parenteral sedation regimen for magnetic resonance imaging (MRI) has not been determined. This prospective, interventional study aimed to investigate the efficacy and safety of buccal midazolam in combination with intranasal dexmedetomidine in children undergoing MRI.MethodsChildren between 1 month and 10 years old requiring sedation for MRI examination were recruited to receive buccal midazolam 0.2 mg⋅kg–1 with intranasal dexmedetomidine 3 μg⋅kg–1. The primary outcome was successful sedation following the administration of the initial sedation regimens and the completion of the MRI examination.ResultsSedation with dexmedetomidine–midazolam was administered to 530 children. The successful sedation rate was 95.3% (95% confidence interval: 93.5–97.1%) with the initial sedation regimens and 97.7% (95% confidence interval: 96.5–99%) with a rescue dose of 2 μg⋅kg–1 intranasal dexmedetomidine. The median sedation onset time was 10 min, and a significant rising trend was observed in the onset time concerning age (R = 0.2491, P < 0.001). The wake-up and discharge times significantly correlated with the duration of the procedure (R = 0.323, P < 0.001 vs. R = 0.325, P < 0.001). No oxygen deficiency nor medication intervention due to cardiovascular instability was observed in any of the patients. History of a prior failed sedation was considered a statistically significant risk factor for failed sedation in the multivariate logistic regression model [odds ratio = 4.71 (95% confidence interval: 1.24–17.9), P = 0.023].ConclusionIn MRI examinations, the addition of buccal midazolam to intranasal dexmedetomidine is associated with a high success rate and a good safety profile. This non-parenteral sedation regimen can be a feasible and convenient option for short-duration MRI in children between 1 month and 10 years.

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Section: Discussionsupporting

confidence: 92%

Using intranasal dexmedetomidine with buccal midazolam for magnetic resonance imaging sedation in children: A single-arm prospective interventional study

Luo

Huang

et al. 2022

Front. Pediatr.

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“…Remarkably, when compared with other studies in the literature, our data on the success rate of the combination of intranasal ketamine and intranasal dexmedetomidine showed a lower percentage of successful procedures, despite the higher dosages used in order to identify a possibly more effective dose, 3 mg/kg and 4 mcg/kg versus 1 mg/kg and 2 mcg/kg respectively [ 2 , 3 ]. These different results may be due to the use of diluted galenic dexmedetomidine (50mcg/ml) in our Institute, versus the 100 mcg/ml strength of the standard iv drug, suggesting a lower effectiveness of a more diluted formulation.…”

Section: Discussionsupporting

confidence: 42%

“…Among the different possible strategies in non-painful procedures, two recent studies investigated the efficacy of the combination of intranasal dexmedetomidine (2 mcg/kg) and intranasal ketamine (1 mg/kg) for pediatric procedural sedation. These series showed that over 90% of patients completed the procedure without a sedative rescue treatment [ 2 , 3 ]. Our standard of care in this setting consists of the association between oral midazolam (0.5 mg/kg) and intranasal dexmedetomidine (4 mcg/kg).…”

Section: Introductionmentioning

confidence: 99%

Intranasal dexmedetomidine and intranasal ketamine association allows shorter induction time for pediatric sedation compared to intranasal dexmedetomidine and oral midazolam

et al. 2022

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Background Non-painful diagnostic procedures require an inactive state for a prolonged time, so that sedation is often needed in younger children to perform the procedures. Our standard of care in this setting consists of the association between oral midazolam (0.5 mg/kg) and intranasal dexmedetomidine (4 mcg/kg). One of the limits of this approach is that the onset of action is quite delayed (up to 55 min) and poorly predictable. We chose to compare this association with intranasal-ketamine and intranasal-dexmedetomidine. Methods This is a “pre-post” study. The study population included the first forty children receiving sedation with the “new” combination intranasal ketamine (3 mg/kg) and intranasal dexmedetomidine (4 mcg/kg) compared to a historical cohort including the last forty children receiving sedation with our standard of care combination of intranasal dexmedetomidine (4mcg/kg) and oral midazolam (0,5 mg/kg). Results The association intranasal dexmedetomidine and intranasal ketamine allowed for a significantly shorter sedation induction time than the combination intranasal dexmedetomidine and oral midazolam (13,5 min versus 35 min). Both group’s cumulative data showed a correlation between age and sedation effectiveness, with younger children presenting a higher success rate and shorter induction time (p 0,001). Conclusions: This study suggests that the ketamine and dexmedetomidine intranasal association may have a shorter onset of action when compared to intranasal dexmedetomidine and oral midazolam.

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“…Ketamine is a phencyclidine derivative with sedative and analgesic effects (34). It can cause cardiovascular effects, such as hypertension, tachycardia, but preserves cardiac output and therefore is often used in patients with hypovolemia or haemodynamic disorders (35). Ketamine is usually administered intravenously (IV) or IM, but it may also be administered intranasally (36).…”

Section: Ketaminementioning

confidence: 99%

“…Furthermore, combined with dexmedetomidine, IN ketamine seems to be an effective and safe sedative, with no severe adverse reaction, in particular during diagnostic examinations, as color-doppler ultrasound, pulmonary function, EEG, MRI, ECG, ABR, fundus examination, CT scan and transthoracic echocardiography (35,41).…”

Section: Ketaminementioning

confidence: 99%

Intranasal drugs for analgesia and sedation in children admitted to pediatric emergency department: a narrative review

Pansini¹,

Curatola²,

Gatto³

et al. 2021

Ann Transl Med

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Acute pain is one of the most common symptoms in children admitted to the Pediatric Emergency Department (PED) and its management represents a real clinical challenge for pediatricians.Different painful procedures can be very stressful for young children and their perception of pain can be enhanced by emotional factors, such as anxiety, distress, or anger. Adequate procedural sedation reduces anxiety and emotional trauma for the patient, but it reduces also stress for operators and the time for procedures. We have reviewed the literature on this topic and the drugs covered in these papers were: midazolam, fentanyl, ketamine, and dexmedetomidine. There are several routes of administering for these drugs to provide analgesia and anxiolysis to children: oral, parenteral, or intranasal (IN). Intravenous (IV) sedation, since it involves the use of needles, can be stressful; instead, IN route is a non-invasive procedure and generally well tolerated by children and it has become increasingly widespread. Some medications can be administered by a mucosal atomizer device (MAD) or by drops. The benefits of the atomized release include less drug loss in the oropharynx, higher cerebrospinal fluid levels, better patient acceptability, and better sedative effects. IN midazolam has a sedative, anxiolytic and amnesic effect, but without analgesic properties.Fentanyl and ketamine are mainly used for pain control. Dexmedetomidine has anxiolytic and analgesic properties. In conclusion, IN analgo-sedation is a simple, rapid and painless option to treat pain and anxiety in the PED requiring brief training on the administration process and experience in sedation.

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Sedation effects of intranasal dexmedetomidine combined with ketamine and risk factors for sedation failure in young children during transthoracic echocardiography

Cited by 17 publications

References 26 publications

Using intranasal dexmedetomidine with buccal midazolam for magnetic resonance imaging sedation in children: A single-arm prospective interventional study

Using intranasal dexmedetomidine with buccal midazolam for magnetic resonance imaging sedation in children: A single-arm prospective interventional study

Intranasal dexmedetomidine and intranasal ketamine association allows shorter induction time for pediatric sedation compared to intranasal dexmedetomidine and oral midazolam

Intranasal drugs for analgesia and sedation in children admitted to pediatric emergency department: a narrative review

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