Sedation in children - is it time to change our practice?

Bailey, Craig R.

doi:10.1111/anae.13447

Cited by 9 publications

(6 citation statements)

References 27 publications

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“…Oral chloral hydrate is the most commonly used sedative in children for ABR test; 1 intranasal dexmedetomidine is used increasingly for other non-painful procedural sedation. [2][3][4][5][6] The successful sedation rate of intranasal dexmedetomidine was similar to oral chloral hydrate for computer tomography studies, but intranasal dexmedetomidine was associated with better behavior and less gastrointestinal side effects. 7 While CT studies are short and nonstimulating, ABR tests lasts longer and are more stimulating.…”

Section: Introductionmentioning

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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Section: Introductionmentioning

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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“…Similar problems have not been identified with dexmedetomidine . Intranasal dexmedetomidine appears to be a safer and more acceptable method of sedating children than oral chloral hydrate .…”

Section: Discussionmentioning

confidence: 65%

A randomised controlled trial of oral chloral hydrate vs. intranasal dexmedetomidine before computerised tomography in children

Yuen

Cheuk

et al. 2017

Anaesthesia

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Chloral hydrate is commonly used to sedate children for painless procedures. Children may recover more quickly after sedation with dexmedetomidine, which has a shorter half-life. We randomly allocated 196 children to chloral hydrate syrup 50 mg.kg and intranasal saline spray, or placebo syrup and intranasal dexmedetomidine spray 3 μg.kg , 30 min before computerised tomography studies. More children resisted or cried after drinking chloral hydrate syrup than placebo syrup, 72 of 107 (67%) vs. 42 of 87 (48%), p = 0.009, but there was no difference after intranasal saline vs. dexmedetomidine, 49 of 107 (46%) vs. 40 of 87 (46%), p = 0.98. Sedation was satisfactory in 81 of 107 (76%) children after chloral hydrate and 64 of 87 (74%) children after dexmedetomidine, p = 0.74. Of the 173 children followed up for at least 4 h after discharge, 38 of 97 (39%) had recovered normal function after chloral hydrate and 32 of 76 (42%) after dexmedetomidine, p = 0.76. Six children vomited after chloral hydrate syrup and placebo spray vs. none after placebo syrup and dexmedetomidine spray, p = 0.03.

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“…Pharma, Espoo, Finland) is a widely-used sedation drug in paediatric procedures [4,[9][10][11][12]. It was approved by the US Food and Drug Administration in 1999 and subsequently approved for use in the European Union in 2011 [13].…”

Section: Dexmedetomidine (Dexdorâ Orion Corporation Orionmentioning

confidence: 99%

Nurse‐led dexmedetomidine sedation for magnetic resonance imaging in children: a 6‐year quality improvement project

Lin

Elder

et al. 2023

Anaesthesia

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We aimed to safely introduce dexmedetomidine into a nurse-led sedation service for magnetic resonance imaging in children. Secondary aims were to increase the number of children eligible for sedation and to increase the actual number of children having sedation performed by our nurse sedation team. We analysed 1768 consecutive intravenous and 219 intranasal dexmedetomidine sedation episodes in infants, children and adolescents having magnetic resonance imaging scans between March 2016 and March 2022. The overall sedation success rate was 98.4%, with a 98.9% success rate for intravenous dexmedetomidine and a 95.0% success rate for intranasal dexmedetomidine. The incidence of scan interruption during intravenous and intranasal dexmedetomidine sedation was 8.8% and 21.9%, respectively. We conclude that paediatric sedation with dexmedetomidine for magnetic resonance scanning is safe and successful.

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Sedation in children - is it time to change our practice?

Cited by 9 publications

References 27 publications

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

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

A randomised controlled trial of oral chloral hydrate vs. intranasal dexmedetomidine before computerised tomography in children

Nurse‐led dexmedetomidine sedation for magnetic resonance imaging in children: a 6‐year quality improvement project

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