Dexmedetomidine as a sole sedative for procedural sedation in preterm and neonate infants: A retrospective analysis

Abstract

Background: Many different sedation concepts for magnetic resonance imaging have been described for prematurely and term-born infants, ranging from "no sedation" to general anesthesia. Dexmedetomidine is an alpha-2 receptor agonist that is frequently used to sedate older children, because the anesthesiologist can easily adjust sedation depth, the patient maintains spontaneous breathing, and awakens rapidly afterwards. Aims:The present study evaluates whether dexmedetomidine could safely be used as the sole sedative for prematurely and term-born infants less than 60 weeks postconceptional age undergoing diagnostic procedures. Methods:We performed a retrospective monocentric analysis of n = 39 prematurely and term-born infants (<60 weeks postconceptional age or a body weight <5 kg) who were sedated with dexmedetomidine for an MRI at a German university hospital from August 2016 to November 2018.Results: Successful imaging was achieved in all cases. The median initial bolus of dexmedetomidine administered over 10 min was 1.39 μg kg −1 body weight (range 0.34-3.64 μg kg −1 ), followed with a continuous infusion at a median rate of 1.00 μg kg −1 h −1 (range 0.5-3.5 μg kg −1 h −1 ); however, 3 patients (7%) needed some additional sedation (ketamine or propofol). All patients, including 10 infants who had previously required respiratory support, underwent the procedure without any relevant desaturation or apnea. Bradycardia was observed in up to 15 out of 39 cases (38.5%), but only four (10.3% in total and 26.7% of bradycardia) required atropine. Conclusions:These results indicate that dexmedetomidine can be safely used for procedural sedation in the high-risk cohort of prematurely and term-born infants less than 60 weeks postconceptional age. Apnea during procedural sedation and subsequent stay in the recovery room is avoided, but bradycardia remains a relevant risk that may require treatment. K E Y W O R D S apnea, bradycardia, dexmedetomidine, prematurely and term-born infants less than 60 weeks postconceptional age, procedural sedation How to cite this article: Leister N, Yücetepe S, Ulrichs C, et al. Dexmedetomidine as a sole sedative for procedural sedation in preterm and neonate infants: A retrospective analysis. Pediatr

Deep Sedation in Lateral Position for Preterm Infants during Cerebral Magnetic Resonance Imaging: a Prospective Observational Study

“…Several reports have attempted to address this issue by improving anesthesia sparing techniques, even if it might lead to a lower quality of imaging or necessitate rescheduling new MR appointment [17][18]. Our ndings suggest that lying in lateral position during sedation could reduce respiratory adverse events: oxygen desaturation and apnea episodes occurred in only one (4.3%) and two (8.6%) patients, accounting for an incidence of adverse events in 2/23 (9%) newborns.…”

Application of intranasal dexmedetomidine in magnetic resonance imaging of preterm infants: the ED50, efficacy and safety analysis

“…Nicolas et al investigated the safety of intravenous dexmedetomidine alone for procedural sedation for MRI in preterm and term infants [11]. But, it is di cult for infants to establish intravenous access, moreover, the establishment of intravenous access for MRI examination not only increases the di culty of clinical work, but also increases the psychological burden of family members.…”

“…Olgun et al ulitized intranasal administration of 4 µg/kg dexmedetomidine in infants with an average age of 7 months, and the success rate of MRI sedation was 94.2% [10]. Therefore, Dexmedetomidine has been shown to be less neurotoxic or potentially neuroprotective than other sedatives, and is now widely used for sedation before MRI in infants and young children [11][12][13].…”

Safety and quality in paediatric procedural sedation: what really matters?

“…There is plenty of literature on the dosing, efficacy and safety of dexmedetomidine for paediatric procedural sedation [35 ▪▪ ,36,37 ▪ ]. Although induction of sedation with dexmedetomidine and recovery after the procedure take longer, it has an advantage that airway and spontaneous breathing are not impaired [36,38,39 ▪ ]. Cardiovascular adverse effects such as bradycardia and hypotension are described and occur in 0–22 and 0.6–3.2% of cases, respectively, depending on dosage and rate of injection.…”

“…Bradycardia is often self-limiting and does not need pharmacological intervention [35 ▪▪ ,38,40,41]. Dexmedetomidine can be applied safely particularly in children with cardiac comorbidities [37 ▪ ,42,43] and it is also suitable for all age groups including neonate and preterm infants [39 ▪ ,44].…”