Determination of the 90% effective dose of intranasal dexmedetomidine for sedation during electroencephalography in children

Abstract

EEG is a valuable diagnostic tool for children with epilepsy, delirium and other central nervous system lesions. Children likely experience difficulty falling asleep when they are scheduled to undergo EEG. Therefore, sedation is very important.Sedation for EEG in uncooperative children remains controversial because most anaesthetics and sedatives have some effect on brain waves. Many sedative medications, such as chloral hydrate, hydroxyzine and dexmedetomidine (DEX), have been used in children undergoing EEG. Chloral hydrate is a commonly used sedative in EEG. However, previous studies have shown that chloral hydrate for sedation has a high failure rate of 27% in patients with abnormal behaviour, 1,2 it may increase fast EEG activity, and it has side effects, including respiratory depression, 3 apnoea, airway obstruction, hypoxia, hypotension and hypercarbia. 4 DEX is a highly selective alpha-2 adrenergic agonist that functions as a sedative and an analgesic. DEX has been studied as a suitable sedative agent for children undergoing many procedures, as it has a low risk of side effects and a short half-life. DEX can cause EEG patterns similar to those of sleep stage II with modest increases in θ, α and β activity and has no effect on EEG epileptic activity in children, which makes it a suitable Background: The intranasal route of dexmedetomidine (DEX) administration is becoming increasingly popular for providing adequate sedation during short examinations in infants and children. However, data on the 90% effective dose (ED90) of intranasal DEX are rare in children under 3 years old.Methods: This is a double-blind trial using a biased coin design up-and-down sequential method (BCD-UDM). Fifty-three children aged under 3 years old requiring DEX for EEG were included in our study. The first patient received 2.5 μg kg −1 DEX, and the dose of DEX administered to the subsequent patient was determined by the response of the previous patient. The patient responses were recorded and analysed to calculate the ED90 by isotonic regression. The 95% confidence interval (CI) was estimated using a bootstrapping method.Results: Fifty-three patients were included in our study, of which 45 patients were successfully sedated, and the 8 instances of failed sedation were rescued using sevoflurane inhalation, allowing the completion of the procedure. The 90% effective dose of DEX was calculated to be 3.28 µg kg −1 , and the 95% CI was 2.74 ~ 3.39 µg kg −1 .No significant adverse events occurred in any of the patients. Conclusion:The 90% effective dose of intranasal DEX sedation for EEG was 3.28 μg kg −1 in children under 3 years old.

Dexmedetomidine for Electroencephalogram in patients with behavioural disorders: a comparative study between intranasal and intravenous administration

“…Differently, with intranasal administration there isn't a standard dose, because of the heterogeneity of studies. The mean dose in our population (4.34 ± 0.87 mcg/kg) is higher than what reported in literature [22], maybe it depends on the age of patients included or on the higher number of unsuccessful procedures [15].…”

“…The offset in our study is included in the range described in literature (44-91 minutes) and it wasn't in uenced by the dose administered [22].…”

Comparison of oral triclofos and intranasal midazolam and dexmedetomidine for sedation in children undergoing magnetic resonance imaging (MRI): an open-label, three-arm, randomized trial

“…It has been reported to be non-noxious to the nasal mucosa in different studies [24,25]. But in the present study, nasal discomfort was observed in 2 children with IND administration, which could be due to administration of the drug by a syringe and would have been best avoided with the use of a mucosal atomizer device [28], whereas a success rate of 87% was reported in a similar study using IND at a dose of 2.5 µg/kg [29]. In a recent systematic review, the success rate of IND was shown to vary from 30 to 100% depending on the dose of the drug and type of procedures requiring sedation [10].…”

Intranasal dexmedetomidine is an effective sedative agent for electroencephalography in children

“…In our study, the success rate of the initial dose of 2.5 μg•kg − 1 DEX was 87.0% (3024/3475 cases). A recent study have found that 90% of the effective dose of intranasal DEX sedation was 3.28 μg•kg − 1 in children [23]. Another study found that the 50% effective dose and the 95% effective dose of intranasal DEX increased with increasing age in patients under 3 years of age [24].…”