Comparing the Effects of Dexmedetomidine and Midazolam on Sedation in Children with Head Trauma to Perform CT in Emergency Department / Upoređivanje efekata deksmedetomidina i midazolama na sedaciju dece sa povredom glave radi snimanja CT-om na Odeljenju urgentne medicine

Abstract

Many of the children referred to the emergency complain of head trauma. Children usually require sedition to reduce their failure and fear because of high activity and fear of performing computed tomography (CT). Dexmedetomidine and Midazolam belong to short-acting drugs for this purpose. This study aimed to compare the effect of the above mentioned drugs on sedition in children.Children referred to the emergency department were randomly divided into two groups. Group A was sedated with 0.05 mg/kg IV Midazolam and group B with 2µg/kg IV Dexmedetomidine over 10 minutes (loading dose), and then repeat boluses 2µg/kg IV over 10 minutes. Measurements included induction time, recovery time, efficacy, side effects, complications, and failure with each drug and vital signs and RAMSY scale. SPSS V.20 was used for data analysis. p<0.05 was considered statistically significant.Totally, 100 patients participated in the current study (44 girls and 56 boys). The mean and standard deviation of age was 5.3 ± 2.5 years. During the study, just 5 patients (10%) from group A did not have appropriate sedition following the injection of first dose of Midazolam and received the second dose. However, in B group patients no such case was reported. No significant difference was observed among blood pressure, heart rate, respiration and RAMSY Scale among the groups.No significant difference was seen between efficacy of Midazolam and Dexmedetomidine in pediatric sedation. More research should be done for generalization of our findings .

The use of dexmedetomidine in the emergency department: A systematic review

“…Study designs included 11 RCTs, 22,32–41 13 cohort studies and other nonrandomized studies, 19–21,23,42–50 and 11 case series and case reports 12,51–60 . Six of the included studies were conference abstracts 20,21,40,47,50,56 .…”

“…Intranasal DEX appeared to perform as well as or better than intranasal midazolam for this indication (faster onset of sedation in one trial, 41 no difference in rate of adequate sedation or need for rescue medications in another 35 ). A prospective open-label study demonstrated universally successful sedation for CT imaging in pediatric patients with intranasal DEX, 42 a small retrospective chart review found that DEX facilitated completion of imaging in 86% of adult patients, 21 and four patients in a small pediatric case series were successfully sedated for various imaging tests with intramuscular DEX.…”

“…Study designs included 11 RCTs, 22,[32][33][34][35][36][37][38][39][40][41] 13 cohort studies and other nonrandomized studies, [19][20][21]23,[42][43][44][45][46][47][48][49][50] and 11 case series and case reports. 12,[51][52][53][54][55][56][57][58][59][60] Six of the included studies were conference abstracts.…”

“…Two RCTs, 35,41 four cohort studies and other nonrandomized studies, 21,42,44,45 and one case series 52 reported the use of DEX specifically for sedation to facilitate radiologic imaging, generally in children. As above, pooling of efficacy results was not feasible.…”