Dexmedetomidine is effective and safe during NIV in infants and young children with acute respiratory failure

Piastra, Marco; Pizza, Alessandro; Gaddi, Serena; Luca, Emanuele De; Genovese, Orazio; Picconi, Enzo; Luca, Danièle De; Conti, Giorgio

doi:10.1186/s12887-018-1256-y

Cited by 32 publications

(24 citation statements)

References 34 publications

(38 reference statements)

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“…This effect is possibly mediated via its sedative and analgesic properties. Dexmedetomidine provides analgesia via receptors in the spinal cord, and attenuation of the stress response [28]. As shown in previous studies [13,14], we also found that premedication with intranasal dexmedetomidine reduced the patients' separation anxiety and resulted in more satisfactory tolerance of the facial mask during anesthesia induction.…”

Section: Discussionsupporting

confidence: 86%

Efficacy of intranasal dexmedetomidine for removal of inhaled foreign bodies in children by flexible fiberoptic bronchoscopy: a randomized, double-blind, placebo-controlled clinical trial

et al. 2019

Preprint

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Background: The traditional technique for foreign body removal is rigid bronchoscopy. However, fiberoptic bronchoscopy is becoming more popular for foreign body removal. Compared with rigid bronchoscopy, fiberoptic bronchoscopy is better suited for removing foreign bodies from the distal airways and upper lobe bronchi because of the smaller diameter and greater flexibility of the bronchoscope. Dexmedetomidine, a highly selective α2 adrenergic agonist, reduces preoperative anxiety, reduces the requirement for general anesthetics, and does not induce respiratory depression. The safety and efficacy of intravenous dexmedetomidine have been confirmed in patients undergoing fiberoptic bronchoscopy. Intranasal dexmedetomidine reportedly produce satisfactory sedation in children. We hypothesized that intranasal dexmedetomidine at 1 µg·kg−1 administered 25 minutes before anesthetic induction can reduce the incidence of adverse events during fiberoptic bronchoscopy under sevoflurane inhalation general anesthesia. Methods: Forty preschool-aged children (6–48 months) with an American Society of Anesthesiologists physical status of I or II were randomly allocated to receive either intranasal dexmedetomidine at 1 µg·kg−1 or normal saline at 0.01 ml·kg−1 25 minutes before anesthetic induction. The primary outcome was the incidence of perioperative adverse events. The heart rate, respiratory rate, separation score, tolerance of the anesthetic mask, agitation score, anesthetic induction time, consumption of sevoflurane, and recovery time were also recorded. Results: The incidence of laryngospasm, breath-holding, and coughing were significantly lower in patients who received intranasal dexmedetomidine than saline (15% vs. 50%, P=0.018; 10% vs. 40%, P=0.028; and 5% vs. 30%, P=0.037, respectively). Patients who received intranasal dexmedetomidine had a lower separation score (P=0.017), more satisfactory tolerance of the anesthetic mask (P=0.027), a significantly shorter anesthetic induction time (5.75±1.4 vs. 7.75±2.5 min, P=0.004), and less consumption of sevoflurane (38.18±14.95 vs. 48.03±14.45 ml, P=0.041). The recovery time was similar in both groups, and the frequency of postoperative agitation was significantly lower in patients who received intranasal dexmedetomidine (P=0.004). Conclusions: Intranasal dexmedetomidine at 1 µg·kg−1 can reduce the incidence of laryngospasm, breath-holding, and coughing during fiberoptic bronchoscopy for foreign body removal via its sedative and analgesic effects. Moreover, intranasal dexmedetomidine can reduce postoperative agitation without a prolonged recovery time.

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Section: Discussionsupporting

confidence: 86%

Efficacy of intranasal dexmedetomidine for removal of inhaled foreign bodies in children by flexible fiberoptic bronchoscopy: a randomized, double-blind, placebo-controlled clinical trial

et al. 2019

Preprint

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“…This effect is possibly mediated via its sedative and analgesic properties. Dexmedetomidine provides analgesia via receptors in the spinal cord, and attenuation of the stress response [25]. As shown in previous studies [10, 11], we also found that premedication with intranasal dexmedetomidine reduced the patients’ separation anxiety and resulted in more satisfactory tolerance of the facial mask during anesthesia induction.…”

Section: Discussionsupporting

confidence: 83%

Efficacy of premedication with intranasal dexmedetomidine for removal of inhaled foreign bodies in children by flexible fiberoptic bronchoscopy: a randomized, double-blind, placebo-controlled clinical trial

et al. 2019

BMC Anesthesiol

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BackgroundTracheobronchial foreign body aspiration in children is a life-threatening, emergent situation. Currently, the use of fiberoptic bronchoscopy for removing foreign bodies is attracting increasing attention. Oxygen desaturation, body movement, laryngospasm, bronchospasm, and breath-holding are common adverse events during foreign body removal. Dexmedetomidine, as a highly selective α2-adrenergic agonist, produces sedative and analgesic effects, and does not induce respiratory depression. We hypothesized that intranasal dexmedetomidine at 1 μg kg − 1 administered 25 min before anesthesia induction can reduce the incidence of adverse events during fiberoptic bronchoscopy under inhalation general anesthesia with sevoflurane.MethodsIn all, 40 preschool-aged children (6–48 months) with an American Society of Anesthesiologists physical status of I or II were randomly allocated to receive either intranasal dexmedetomidine at 1 μg·kg − 1 or normal saline at 0.01 ml kg− 1 25 min before anesthesia induction. The primary outcome was the incidence of perioperative adverse events. Heart rate, respiratory rate, parent-child separation score, tolerance of the anesthetic mask, agitation score, consumption of sevoflurane, and recovery time were also recorded.ResultsFollowing pre-anesthesia treatment with either intranasal dexmedetomidine or saline, the incidences of laryngospasm (15% vs. 50%), breath-holding (10% vs. 40%), and coughing (5% vs. 30%) were significantly lower in patients given dexmedetomidine than those given saline. Patients who received intranasal dexmedetomidine had a lower parent–child separation score (P = 0.017), more satisfactory tolerance of the anesthetic mask (P = 0.027), and less consumption of sevoflurane (38.18 ± 14.95 vs. 48.03 ± 14.45 ml, P = 0.041). The frequency of postoperative agitation was significantly lower in patients given intranasal dexmedetomidine (P = 0.004), and the recovery time was similar in the two groups.ConclusionsIntranasal dexmedetomidine 1 μg·kg− 1, with its sedative and analgesic effects, reduced the incidences of laryngospasm, breath-holding, and coughing during fiberoptic bronchoscopy for FB removal. Moreover, it reduced postoperative agitation without a prolonged recovery time.Trail registrationThe study was registered with the Chinese Clinical Trial Registry (registration number: ChiCTR1800017273) on July 20, 2018.

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“…Studies have shown that procedural sedation and analgesia as a salvage strategy are both safe and effective for patients intolerant to NIV (8)(9)(10)(11). However, to date, there is no consensus on sedation protocols for such patients (12).…”

Section: Introductionmentioning

confidence: 99%

Remifentanil versus dexmedetomidine for treatment of cardiac surgery patients with moderate to severe noninvasive ventilation intolerance (REDNIVIN): a prospective, cohort study

et al. 2020

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Background: The use of sedation to noninvasive ventilation (NIV) patients remains controversial, however, for intolerant patients who are uncooperative, administration of analgesics and sedatives may be beneficial before resorting to intubation. The aim of this study was to evaluate the efficacy of remifentanil (REM) versus dexmedetomidine (DEX) for treatment of cardiac surgery (CS) patients with moderate to severe NIV intolerance. Methods: This prospective cohort study of CS patients with moderate to severe NIV intolerance was conducted between January 2018 and March 2019. Patients were treated with either REM or DEX, decided by the bedside intensivist. Depending on the treatment regimen, the patients were allocated to one of two groups: the REM group or DEX group. Results: A total of 90 patients were enrolled in this study (52 in the REM group and 38 in the DEX group).The mitigation rate, defined as the percentage of patients who were relieved from the initial moderate to severe intolerant status, was greater in the REM group than DEX group at 15 min and 3 h (15 min: 83% vs. 61%, P=0.029; 3 h: 92% vs. 74%, P=0.016), although the mean mitigation rate (81% vs. 85%, P=0.800) was comparable between the two groups. NIV failure, defined as reintubation or death over the course of study, was comparable between the two groups (19.2% vs. 21.1%, respectively, P=0.831). There were no significant differences between the two groups in other clinical outcomes, including tracheostomy (15.4% vs.15.8%, P=0.958), in-hospital mortality (11.5% vs. 10.5%, P=0.880), ICU length of stay (LOS) (7 vs. 7 days, P=0.802), and in-hospital LOS (17 vs. 19 days, P=0.589). Conclusions: REM was as effective as DEX in CS patients with moderate to severe NIV intolerance.Although the effect of REM was better than that of DEX over the first 3 h, the cumulative effect was similar between the two treatments.

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Dexmedetomidine is effective and safe during NIV in infants and young children with acute respiratory failure

Cited by 32 publications

References 34 publications

Efficacy of intranasal dexmedetomidine for removal of inhaled foreign bodies in children by flexible fiberoptic bronchoscopy: a randomized, double-blind, placebo-controlled clinical trial

Efficacy of intranasal dexmedetomidine for removal of inhaled foreign bodies in children by flexible fiberoptic bronchoscopy: a randomized, double-blind, placebo-controlled clinical trial

Efficacy of premedication with intranasal dexmedetomidine for removal of inhaled foreign bodies in children by flexible fiberoptic bronchoscopy: a randomized, double-blind, placebo-controlled clinical trial

Remifentanil versus dexmedetomidine for treatment of cardiac surgery patients with moderate to severe noninvasive ventilation intolerance (REDNIVIN): a prospective, cohort study

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