Feasibility of measuring memory response to increasing dexmedetomidine sedation in children

Mason, Keira P.; Kelhoffer, Eric R.; Prescilla, Randy; Mehta, Meghana; Root, James C.; Young, Vanessa; Robinson, Fay; Veselis, Robert A.

doi:10.1093/bja/aew421

Cited by 6 publications

(5 citation statements)

References 42 publications

(20 reference statements)

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“…Per definition, patient responsiveness is higher with minimal sedation, possibly a factor that lends itself to the suggestion that, at lower depths of sedation, the greater the attention and response to stimulus, the higher the subsequent risk of recall [36]. These findings support similar findings with dexmedetomidine and propofol, supporting that children who are verbally responsive to visual and verbal stimuli have a higher incidence of recall [11,12]. It should be noted, however, that increasing the level of sedation increases the risk of respiratory and airway adverse events [23].…”

Section: Discussionmentioning

confidence: 52%

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Amnesia after Midazolam and Ketamine Sedation in Children: A Secondary Analysis of a Randomized Controlled Trial

Viana

Moterane

Green

et al. 2021

JCM

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The incidence of peri-procedural amnesia following procedural sedation in children is unclear and difficult to determine. This study aimed to apply quantitative and qualitative approaches to better understand amnesia following dental sedation of children. After Institutional Review Board Approval, children scheduled for sedation for dental procedures with oral midazolam (OM), oral midazolam and ketamine (OMK), or intranasal midazolam and ketamine (IMK) were recruited for examination of peri-procedural amnesia. Amnesia during the dental session was assessed using a three-stage method, using identification of pictures and an animal toy. On the day following the sedation, primary caregivers answered two questions about their children’s memory. One week later, the children received a semi-structured interview. Behavior and level of sedation during the dental session were recorded. Quantitative data were analyzed using descriptive statistics and comparison tests. Qualitative data were analyzed using content analysis. Triangulation was used. Thirty-five children (age: 36 to 76 months) participated in the quantitative analysis. Most children showed amnesia for the dental procedure (82.9%, n = 29/35) and remembered receiving the sedation (82.1%, n = 23/28 for oral administration; 59.3%, n = 16/27 for intranasal administration). The occurrence of amnesia for the dental procedure was slightly higher in the oral midazolam group compared with the other groups (44.8%, n = 13/29 for OM, 13.8%, n = 4/29 for OMK, and 41.4%, n = 12/29 for IMK). Twenty-eight children participated in the qualitative approach. The major theme identified was that some children could remember their procedures in detail. We conclude that peri-procedural amnesia of the dental procedure was common following sedation.

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Section: Discussionmentioning

confidence: 52%

“…Factors associated with amnesia include patient characteristics, level of sedation, and the method used to evaluate amnesia [10]. Establishing memory and recall in the pediatric population is challenging, with quantitative methods most frequently employed [9,11,12].…”

Section: Of 13mentioning

confidence: 99%

Amnesia after Midazolam and Ketamine Sedation in Children: A Secondary Analysis of a Randomized Controlled Trial

Viana

Moterane

Green

et al. 2021

JCM

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“…Even without a pediatric label, additions to the literature on pediatric applications of DEX have risen in the last few years [ 4 ]. DEX has numerous properties that make it beneficial as a sedative and anesthetic; it has been documented to sedate in a manner that is similar to natural sleep, and it is used as an anxiolytic, analgesic, and sympatholytic [ 1 , 2 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…Dexmedetomidine (DEX), a highly selective α 2 -adrenoreceptor agonist, offers anxiolytic, sedative, and analgesic effects with negligible respiratory depression [ 1 – 3 ].DEX has been approved for use in adults, but the US Food and Drug Administration has not approved the drug for children. However, DEX has been documented in pediatric patients as a premedication, a sedative in the pediatric intensive care unit, in conjunction with inhaled anesthetic agents, and as a therapeutic for the prevention and treatment of emergence agitation (EA) following general anesthesia [ 4 – 6 ]. EA, particularly in children, presents a great challenge to good patient care [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of different doses of dexmedetomidine as a rapid bolus for children: a double-blind, prospective, randomized study

Chen

Wang

et al. 2018

BMC Anesthesiol

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BackgroundDexmedetomidine (DEX), a highly sensitive α2-adrenoceptor agonist that possesses anxiolytic, sedative, and analgesic effects, has been documented as a preventative and treatment for emergence agitation (EA). The therapeutic should be given as a loading dose that is infused during a 10 min period, but if a rapid bolus injection is deemed to be hemodynamically appropriate, it would be a more opportune route of administration. So we studied the efficacy of different doses of DEX as a rapid bolus for children to prevent and treat EA.MethodsOne hundred patients were enrolled and randomly divided into five groups: the control group (group D1), the 0.25 μg/kg DEX group (group D2), the 0.5 μg/kg DEX group (group D3), the 0.75 μg/kg DEX group (group D4), and the 1 μg/kg DEX group (group D5). Heart rate (HR), mean blood pressure (MBP) and blood oxygen saturation (SaO2) were recorded immediately before the study drug injection (baseline) and every minute for 5 min thereafter and at the time points of the skin cut and hernial sac pull. EA and pain were assessed in the post -anesthesia care unit, and any complementary medicine and adverse events were recorded too.ResultsThe incidence of EA was significantly decreased in group D4 and group D5 compared with D1.All groups exhibited similar baseline HR and MBP. After administered, HR and MBP were significantly decreased in all DEX group compared with group D1.In groups D3, D4 and D5, the minimal HR was decreased significantly compared with the groups D1 and duration time of minimal HR significantly prolonged in group D5, but no patient needed treatment. As the dosage increased, the recovery time was significantly prolonged. There were no significant differences in occurrence time of minimal HR, the incidence of complementary medicine and adverse events among groups.ConclusionRapid intravenous injection (IV) bolus administration of 0.75 and 1.0 μg/kg of DEX could improve the recovery profile by reducing the incidence of EA in children. Although its use resulted in a transient decreases in HR and MBP, DEX was clinically well-tolerated in children.Trial registrationNo. ChiCTR-IPR-17010658. Registered 17 February 2017.

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“…Just as observed in adults, dexmedetomidine has shown useful in diverse areas in pediatric anesthesia where its sedative properties are useful for premedication, 21 fiberoptic intubation, 22 and radiologic procedures. 23 Its use as an adjunct for balanced anesthesia where it could decrease the use of other drugs, reduce emergence delirium, postoperative shivering, and vomiting, and exhibit neuroprotective effects. 22 , 24 Dexmedetomidine is an effective sedative for infants and children that only minimally depresses the respiratory system while maintaining a patent airway.…”

Section: Application In Pediatrics/childrenmentioning

confidence: 99%

Recent Advances in the Clinical Value and Potential of Dexmedetomidine

Liu¹,

Li²,

Kang³

et al. 2021

JIR

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Dexmedetomidine, a highly selective α2-adrenoceptor agonist, has sedative, anxiolytic, analgesic, sympatholytic, and opioid-sparing properties and induces a unique sedative response which shows an easy transition from sleep to wakefulness, thus allowing a patient to be cooperative and communicative when stimulated. Recent studies indicate several emerging clinical applications via different routes. We review recent data on dexmedetomidine studies, particularly exploring the varying routes of administration, experimental implications, clinical effects, and comparative advantages over other drugs. A search was conducted on the PubMed and Web of Science libraries for recent studies using different combinations of the words “dexmedetomidine”, “route of administration”, and pharmacological effect. The current routes, pharmacological effects, and application categories of dexmedetomidine are presented. It functions by stimulating pre- and post-synaptic α2-adrenoreceptors within the central nervous system, leading to hyperpolarization of noradrenergic neurons, induction of an inhibitory feedback loop, and reduction of norepinephrine secretion, causing a sympatholytic effect, in addition to its anti-inflammation, sleep induction, bowel recovery, and sore throat reduction effects. Compared with similar α2-adrenoceptor agonists, dexmedetomidine has both pharmacodynamics advantage of a significantly greater α2:α1-adrenoceptor affinity ratio and a pharmacokinetic advantage of having a significantly shorter elimination half-life. In its clinical application, dexmedetomidine has been reported to present a significant number of benefits including safe sedation for various surgical interventions, improvement of intraoperative and postoperative analgesia, sedation for compromised airways without respiratory depression, nephroprotection and stability of hypotensive hemodynamics, reduction of postoperative nausea and vomiting and postoperative shivering incidence, and decrease of intraoperative blood loss. Although the clinical application of dexmedetomidine is promising, it is still limited and further research is required to enhance understanding of its pharmacological properties, patient selection, dosage, and adverse effects.

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Feasibility of measuring memory response to increasing dexmedetomidine sedation in children

Cited by 6 publications

References 42 publications

Amnesia after Midazolam and Ketamine Sedation in Children: A Secondary Analysis of a Randomized Controlled Trial

Amnesia after Midazolam and Ketamine Sedation in Children: A Secondary Analysis of a Randomized Controlled Trial

Efficacy of different doses of dexmedetomidine as a rapid bolus for children: a double-blind, prospective, randomized study

Recent Advances in the Clinical Value and Potential of Dexmedetomidine

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