Comparison of Dexmedetomidine With Pentobarbital for Pediatric MRI Sedation

Teshome, Getachew; Belani, Kiran; Braun, Janet L.; Constantine, Diane R.; Gattu, Rajender; Lichenstein, Richard

doi:10.1542/hpeds.2013-0111

Cited by 8 publications

(4 citation statements)

References 30 publications

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“…Generally, a lack of respiratory depression combined with a relatively short half-life makes dexmedetomidine a useful single sedative agent for an ambulatory pediatric MRI setting. However, in spite of a similar success rate, it has slower onset and longer recovery compared to propofol in children undergoing MRI [ 54 , 57 , 58 ].…”

Section: Drugs For Deep Sedation or General Anesthesia For Pediatric mentioning

confidence: 99%

Drug selection for sedation and general anesthesia in children undergoing ambulatory magnetic resonance imaging

Jung

2020

Yeungnam Univ J Med

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The prevalence of magnetic resonance imaging (MRI) for diagnosing and monitoring a wide range of disease in children continues to expand with the efficacy benefit of providing high-resolution images of tissue anatomy and quantitative function and the safety advantage of a lack of ionizing radiation [1,2]. Aspects of MRI scans such as loud noises, confined bore of the magnet, and the required immobility to prevent motion artifacts are the causes of anxiety and barriers to successful performance of the procedure in children younger than 6 years and those at any age with development delay, claustrophobia, or involuntary movements or con-The demand for drug-induced sedation for magnetic resonance imaging (MRI) scans have substantially increased in response to increases in MRI utilization and growing interest in anxiety in children. Understanding the pharmacologic options for deep sedation and general anesthesia in an MRI environment is essential to achieve immobility for the successful completion of the procedure and ensure rapid and safe discharge of children undergoing ambulatory MRI. For painless diagnostic MRI, a single sedative/anesthetic agent without analgesia is safer than a combination of multiple sedatives. The traditional drugs, such as chloral hydrate, pentobarbital, midazolam, and ketamine, are still used due to the ease of administration despite low sedation success rate, prolonged recovery, and significant adverse events. Currently, dexmedetomidine, with respiratory drive preservation, and propofol, with high effectiveness and rapid recovery, are preferred for children undergoing ambulatory MRI. General anesthesia using propofol or sevoflurane can also provide predictable rapid time to readiness and scan times in infants or children with comorbidities. The selection of appropriate drugs as well as sufficient monitoring equipment are vital for effective and safe sedation and anesthesia for ambulatory pediatric MRI.

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Section: Drugs For Deep Sedation or General Anesthesia For Pediatric mentioning

confidence: 99%

Drug selection for sedation and general anesthesia in children undergoing ambulatory magnetic resonance imaging

Jung

2020

Yeungnam Univ J Med

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“…Pentobarbital has been reported in many studies to be associated with a higher risk of complications, including hypotension, respiratory depression, and prolonged recovery time. 5,15,[18][19][20][21] When the intravenous form of pentobarbital (50 mg/mL) is used orally, the volume needed to achieve the desired sedation effect is small allowing for ease in administration.…”

Section: Discussionmentioning

confidence: 99%

Is Orally Administered Pentobarbital a Safe and Effective Alternative to Chloral Hydrate for Pediatric Procedural Sedation?

Anderson¹,

Dalabih²,

Birisi³

et al. 2018

The Journal of Pediatric Pharmacology and Therapeutics

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OBJECTIVES Chloral hydrate had been extensively used for children undergoing sedation for imaging studies, but after the manufacturer discontinued production, pediatric sedation providers explored alternative sedation medications. Those medications needed to be at least as safe and as effective as chloral hydrate. In this study, we examined if pentobarbital is a suitable replacement for chloral hydrate. METHODS Subjects who received pentobarbital were recruited from a prospectively collected database, whereas we used a retrospective chart review to study subjects who received chloral hydrate. Sedation success was defined as the ability to provide adequate sedation using a single medication. We included electively performed sedations for subjects aged 2 months to 3 years who received either pentobarbital or chloral hydrate orally. We excluded subjects stratified as American Academy of Anesthesiologists category III or higher and those who received sedation for electroencephalogram. The data collected captured subject demographics and complications. RESULTS Five hundred thirty-four subjects were included in the final analysis, 368 in the chloral hydrate group and 166 in the pentobarbital group. Subjects who received pentobarbital had a statistically significant higher success rate [136 (82%) vs 238 (65%), p < 0.001], but longer sleeping time (18.1% vs 0%, p < 0.001) in all age groups. Subjects who received chloral hydrate had a higher risk of airway complications in the <1 year of age group (6.5% vs 1.8%, p = 0.03). CONCLUSIONS For pediatric patients younger than 3 years of age undergoing sedation for imaging studies, oral pentobarbital may be at least as effective and as safe as chloral hydrate, making it an acceptable and practical alternative.

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“…[20][21][22] When compared to pentobarbital, one study showed that dexmedetomidine had a shorter recovery time and total sedation time. 23 Other studies showed that ketamine has a significantly shorter onset of sedation compared to dexmedetomidine, with no significant differences in sedation failure, recovery time, separation, and sedation score.…”

Section: Comparison Of Dexmedetomidine To Other Agents For Mrimentioning

confidence: 97%

The Use of Dexmedetomidine on Pediatrics Undergoing MRI Examinations

Suprobo

Yupono

Vitraludyono

2021

JAP

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Dexmedetomidine, an α2 adrenergic agonist, has been commonly used as an off-label anesthetic adjuvant in various procedures and age groups. Lately, dexmedetomidine is increasingly preferred as sedation for pediatric patients undergoing MRI, which requires the patient to remain still in a deep sedation without disturbing airway patency. Dexmedetomidine administration via intranasal or buccal route is preferred for pediatric patients. Dexmedetomidine does not undergo significant pharmacokinetic changes when used in conjunction with other anesthetics, and has a good safety profile. It is 8-10 times more selective against α2 receptors than clonidine and produces sedation, analgesia, vasodilation, and bradycardia without significant airway and respiratory depression risk. Unlike other anesthetic agents, dexmedetomidine does not have any negative effect on brain development. Compared with propofol, dexmedetomidine has a longer onset and duration of action. Thus, dexmedetomidine can be used as the sole sedating agent in infants and children undergoing MRI procedures, with good sedation results and minimal side effects. However, correct dosing is very important given the side effects of bradycardia and hypotension that can occur with its use.

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Comparison of Dexmedetomidine With Pentobarbital for Pediatric MRI Sedation

Abstract: Dexmedetomidine and pentobarbital can both be used successfully for MRI sedation in children. However, dexmedetomidine had a significantly shorter recovery time and total sedation time in our population.

Cited by 8 publications

References 30 publications

Drug selection for sedation and general anesthesia in children undergoing ambulatory magnetic resonance imaging

Drug selection for sedation and general anesthesia in children undergoing ambulatory magnetic resonance imaging

Is Orally Administered Pentobarbital a Safe and Effective Alternative to Chloral Hydrate for Pediatric Procedural Sedation?

The Use of Dexmedetomidine on Pediatrics Undergoing MRI Examinations

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