Comparison of Intranasal Dexmedetomidine and Oral Pentobarbital Sedation for Transthoracic Echocardiography in Infants and Toddlers: A Prospective, Randomized, Double-Blind Trial

Abstract

Intranasal dexmedetomidine was comparable to oral pentobarbital sedation for TTEcho sedation in infants and did not increase the risk of clinically important adverse events. Intranasal dexmedetomidine appears to be an effective "rescue" sedative for both failed pentobarbital and dexmedetomidine sedation. Dexmedetomidine could be a safer option for repeated sedation in children, but further studies are needed to assess long-term consequence of repeated sedation in this high-risk population.

Does intranasal dexmedetomidine provide adequate plasma concentrations for sedation in children: a pharmacokinetic study

“…13,28 Initial hypertension with intranasal administration of dexmedetomidine in children has not been reported, although most studies have deferred blood pressure measurement before the onset of sedation. 7,10 In the present study, no hypertension requiring treatment was observed by arterial pressure monitoring, albeit in anaesthetised patients. The relatively slow absorption and low maximum plasma concentration observed after nasal administration may explain why initial hypertension and bradycardia are not commonly reported with this route.…”

“…29,30 Published pharmacodynamic data in young children sedated with intranasal dexmedetomidine from our institution and others show adequate sedation for non-painful procedures at approximately 20e30 min after administration, with duration of approximately 30e60 min. 7,10,29 We performed intranasal administration by atomisation, which has several potential advantages over simple nasal drop administration, such as uniform application throughout the nasal mucosa to maximise the area of absorption. However, a recent clinical study showed no difference between the two techniques with slow incremental administration of the nasal drops.…”

The association of the optimal bolus of dexmedetomidine with its favourable haemodynamic outcomes in adult surgical patients under general anaesthesia

“…A biphasic cardiovascular response has been reported for DEX with a transient hypertension followed by hypotension . The transient hypertension can be avoided by a slow infusion . DEX causes peripheral vasoconstriction and bradycardia when the plasma concentration exceeds 1000 pg/mL .…”

DEX Marks the Spot: Finding the Optimal Sedation Regimen for Pediatric Patients Undergoing Sedated Transthoracic Echocardiography

“…Owing to the inherent risks associated with sedating or anesthetizing this population, coupled with recent U.S. Food and Drug Administration warnings about repeated or lengthy episodes of sedation or anesthesia in young children, there has been increasing interest in optimizing sedation regimens for patients with CHD. 4 Intranasal medications have the potential to be easily administered and, although they carry some degree of discomfort, may be less traumatic than peripheral intravenous catheter (PIV) placement or intramuscular (IM) administration. Several anesthesia regimens have been under investigation for the pediatric CHD population, including oral pentobarbital, intranasal DEX, and combinations of intranasal DEX with oral or intranasal KET.…”

“…5,8 Side effects from these studies included bradycardia and hypotension, which occurred independent of the dose of DEX. 4,8 Conversely, ketamine, an NMDA antagonist can cause hypertension and tachycardia. As such, Sun et al hypothesized that, compared with DEX alone, combining intranasal DEX-KET may provide adequate sedation with less risk of hemodynamic instability owing to their opposing side effects.…”