Systematic review and meta‐analysis found that intranasal dexmedetomidine was a safe and effective sedative drug during paediatric procedural sedation

Tervonen, Miikka; Pokka, Tytti; Kallio, Merja; Peltoniemi, Outi

doi:10.1111/apa.15348

Cited by 33 publications

(28 citation statements)

References 42 publications

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“…Further inquiry would be necessary to understand why a quarter of children do not have access to N 2 O, a question this survey did not address. Intranasal dexmedetomidine has been gaining adoption in the recent years [ 25 – 29 ], as an efficacious alternative to midazolam for non-painful procedures, with the added advantage, of not being painful during administration unlike midazolam [ 30 ], its effects mimicking sleep, being safe [ 31 ], and being protective in anesthetic neurotoxicity [ 32 – 34 ]. Its availability to only one tenth of the children represented by our study appears reflective of only a slow rise in popularity, perhaps secondary to a longer onset and duration of action than midazolam, which makes it less useful in environments where throughput is important, or secondary to physician familiarity and preference for older medications such as midazolam.…”

Section: Discussionmentioning

confidence: 99%

Pediatric procedural sedation and analgesia in the emergency department: surveying the current European practice

et al. 2021

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Procedural sedation and analgesia outside the operating theater have become standard care in managing pain and anxiety in children undergoing diagnostic and therapeutic procedures. The objectives of this study are to describe the current pediatric procedural sedation and analgesia practice patterns in European emergency departments, to perform a needs assessment-like analysis, and to identify barriers to implementation. A survey study of European emergency departments treating children was conducted. Through a lead research coordinator identified through the Research in European Pediatric Emergency Medicine (REPEM) network for each of the participating countries, a 30-question questionnaire was sent, targeting senior physicians at each site. Descriptive statistics were performed. One hundred and seventy-one sites participated, treating approximately 5 million children/year and representing 19 countries, with a response rate of 89%. Of the procedural sedation and analgesia medications, midazolam (100%) and ketamine (91%) were available to most children, whereas propofol (67%), nitrous oxide (56%), intranasal fentanyl (47%), and chloral hydrate (42%) were less frequent. Children were sedated by general pediatricians in 82% of cases. Safety and monitoring guidelines were common (74%), but pre-procedural checklists (51%) and capnography (46%) less available. In 37% of the sites, the entire staff performing procedural sedation and analgesia were certified in pediatric advanced life support. Pediatric emergency medicine was a board-certified specialty in 3/19 countries. Physician (73%) and nursing (72%) shortages and lack of physical space (69%) were commonly reported as barriers to procedural sedation and analgesia. Nurse-directed triage protocols were in place in 52% of the sites, mostly for paracetamol (99%) and ibuprofen (91%). Tissue adhesive for laceration repair was available to 91% of children, while topical anesthetics for intravenous catheterization was available to 55%. Access to child life specialists (13%) and hypnosis (12%) was rare.Conclusion: Procedural sedation and analgesia are prevalent in European emergency departments, but some sedation agents and topical anesthetics are not widely available. Guidelines are common but further safety nets, nurse-directed triage analgesia, and nonpharmacologic support to procedural sedation and analgesia are lacking. Barriers to implementation include availability of sedation agents, staff shortage, and lack of space. What is Known:• Effective and prompt analgesia, anxiolysis, and sedation (PSA) outside the operating theatre have become standard in managing pain and anxiety in children undergoing painful or anxiogenic diagnostic and therapeutic procedures.• We searched PubMed up to September 15, 2020, without any date limits or language restrictions, using different combinations of the MeSH terms “pediatrics,” “hypnotics and sedatives,” “conscious sedation,” and “ambulatory surgical procedures” and the non-MeSH term “procedural sedation” and found no reports describing the current practice of pediatric PSA in Europe. What is New:• This study is, to the best of our knowledge, the first to shed light on the pediatric PSA practice in European EDs and uncovers important gaps in several domains, notably availability of sedation medications and topical anesthetics, safety aspects such as PSA provider training, availability of nonpharmacologic support to PSA, and high impact interventions such as nurse-directed triage analgesia.• Other identified barriers to PSA implementation include staff shortage, control of sedation medications by specialists outside the emergency department, and lack of space.

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Section: Discussionmentioning

confidence: 99%

Pediatric procedural sedation and analgesia in the emergency department: surveying the current European practice

et al. 2021

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“…[ 30 ] Furthermore, it has little effect on circulatory function and no respiratory depression. [ 31 ] Previous study [ 32 ] has showed that sedation with dexmedetomidine can significantly reduce the incidence of delirium after surgery. Postoperative PCEA can effectively slow the conduction of low-level sympathetic nerves, and block the transmission of noxious stimuli to the central nervous system, significantly reduce the release of inflammatory factors, and reduce the damage of inflammatory factors to the central nervous system.…”

Section: Discussionmentioning

confidence: 99%

The risk factors for cognitive dysfunction in elderly patients after laparoscopic surgery

Fan¹,

Liu²,

Wu³

et al. 2021

Medicine

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Postoperative cognitive dysfunction (POCD) is very common in clinical settings, it is necessary to analyze the risk factors for POCD in elderly patients after laparoscopic surgery to provide insights into clinical surgery management. Elderly patients undergone laparoscopy between September 1, 2018 and March 31, 2020 were included. The mini-mental state examination (MMSE) scale was used to evaluate the POCD, and the characteristics and clinical data of patients with and without POCD were collected and compared. Logistic regression was used to analyze the potential influencing factors. A total of 572 patients with laparoscopic surgery were included. The incidence of POCD was 11.89%. There were significant differences in the history of cerebral infarction, preemptive analgesia, preoperative use of dexmedetomidine, general anesthesia combined with continuous epidural block, duration of surgery, low SpO2 during anesthesia induction, PaCO2 after pneumoperitoneum, postoperative PCEA and VAS score at the third day after operation (all P < .05). Logistic regression analysis revealed that history of cerebral infarction (OR3.12, 1.02∼5.13), low SpO2 during anesthesia induction (OR2.03, 1.19∼4.47), Longer duration of surgery (OR1.82, 1.01∼3.16) were risk factors for POCD in elderly patients with laparoscopic surgery, while postoperative PCEA (OR0.43, 0.01∼0.91), General anesthesia combined with continuous epidural block (OR0.59, 0.04∼0.87), preoperative use of dexmedetomidine (OR0.70, 0.08∼0.94) and preemptive analgesia (OR0.75, 0.13–0.90) were the protective factors for POCD in elderly patients with laparoscopic surgery. For the elderly patients undergoing laparoscopic surgery, the health care providers should be fully alert to the POCD based on those relevant factors.

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“…Dexmedetomidine continues to be described as a novel drug, yet emerging literature suggests its favourable role in paediatric procedural sedation with IN delivery. 2,3 In the paediatric setting, it may produce a higher procedural completion rate than midazolam with a similarly low complication rate when used as a sole sedative. 2 Similar has been found in the paediatric population when used as a pre-medication.…”

Section: Discussionmentioning

confidence: 99%

“…3 It has an estimated sedation onset time of 16.9 min (± 2.6 min) and an estimated duration of sedation of 81.5 min (±4.8 min) with 1-3 mcg/kg doses. 2 More profound and longer sedation is seen with higher doses. 2 In a small study of healthy young adults, estimated sedation onset time was 47.5 min (25-135 min).…”

Section: Role In Procedural Sedationmentioning

confidence: 99%

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Intranasal dexmedetomidine: Procedural sedation in palliative care: A case report

Ferguson

Wilson

2021

Palliat Med

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Background: This report describes the use of intranasal dexmedetomidine to control incident pain and facilitate daily change of dressing in a patient with cutaneous breast cancer. Case presentation: A 45-year-old woman with extensive thoracic cutaneous metastatic bilateral breast cancer requiring daily 2-hour dressing changes to manage significant exudate. Pain during change of dressing was severe and unresponsive to usual analgesics. Deeper sedation was not an option as the patient was required to change position 1 hour into dressing change. Case management: Intranasal dexmedetomidine was administered 40 minutes prior to dressing change and provided effective rousable sedation and analgesia for the duration of the procedure. Case outcome: Dexmedetomidine provided rousable sedation, allowing the patient to follow commands and mobilise during the procedure. Pain was controlled. No adverse cardiovascular effects were noted with the use of intranasal dexmedetomidine. Conclusion: Intranasal dexmedetomidine is a potentially useful medication for procedural sedation in the management of complex wound dressings. It provides rousable short-term sedation, anxiolysis and analgesia. Further research into the role of intranasal dexmedetomidine to facilitate challenging dressing changes in a community setting is warranted.

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Systematic review and meta‐analysis found that intranasal dexmedetomidine was a safe and effective sedative drug during paediatric procedural sedation

Cited by 33 publications

References 42 publications

Pediatric procedural sedation and analgesia in the emergency department: surveying the current European practice

Pediatric procedural sedation and analgesia in the emergency department: surveying the current European practice

The risk factors for cognitive dysfunction in elderly patients after laparoscopic surgery

Intranasal dexmedetomidine: Procedural sedation in palliative care: A case report

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