Efficacy and Safety of Intranasal Dexmedetomidine vs. Oral Chloral Hydrate for Sedation in Children Undergoing Computed Tomography/Magnetic Resonance Imaging: A Meta-Analysis

Lyu, Xiaoqian; Tao, Yujuan; Dang, Xiujing

doi:10.3389/fped.2022.872900

Cited by 6 publications

(4 citation statements)

References 29 publications

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“…However, some studies have shown that Dex has an effect on the cardiovascular system and could be responsible for lowering the heart rate and blood pressure, while the effect on the respiratory rate and saturation is less common ( 21 , 24 – 26 , 34 – 39 ). Nevertheless, our findings are in line with several studies which have demonstrated, that Dex is safe to use in children undergoing EEG ( 40 – 42 ). However, awareness of the possible adverse reactions is essential to prevent potential complications.…”

Section: Discussionsupporting

confidence: 92%

Melatonin vs. dexmedetomidine for sleep induction in children before electroencephalography

Peganc Nunčič,

Neubauer,

Oražem Mrak

et al. 2024

Front. Pediatr.

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Background and objectivesIn children requiring electroencephalography (EEG), sleep recording can provide crucial information. As EEG recordings during spontaneous sleep are not always possible, pharmacological sleep-inducing agents are sometimes required. The aim of the study was to evaluate safety and efficacy of melatonin (Mel) and dexmedetomidine (Dex; intranasal and sublingual application) for sleep induction prior to EEG.MethodsIn this prospective randomized study, 156 consecutive patients aged 1–19 years were enrolled and randomized by draw into melatonin group (Mel; n = 54; dose: 0.1 mg/kg), dexmedetomidine (Dex) sublingual group (DexL; n = 51; dose: 3 mcg/kg) or dexmedetomidine intranasal group (DexN; n = 51; dose: 3 mcg/kg). We compared the groups in several parameters regarding efficacy and safety and also carried out a separate analysis for a subgroup of patients with complex behavioral problems.ResultsSleep was achieved in 93.6% of participants after the first application of the drug and in 99.4% after the application of another if needed. Mel was effective as the first drug in 83.3% and Dex in 99.0% (p < 0.001); in the subgroup of patients with complex developmental problems Mel was effective in 73.4% and Dex in 100% (p < 0.001). The patients fell asleep faster after intranasal application of Dex than after sublingual application (p = 0.006). None of the patients had respiratory depression, bradycardia, desaturation, or hypotension.ConclusionsMel and Dex are both safe for sleep induction prior to EEG recording in children. Dex is more effective compared to Mel in inducing sleep, also in the subgroup of children with complex behavioral problems. Clinical Trial RegistrationDexmedetomidine and Melatonin for Sleep Induction for EEG in Children, NCT04665453.

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Section: Discussionsupporting

confidence: 92%

Melatonin vs. dexmedetomidine for sleep induction in children before electroencephalography

Peganc Nunčič,

Neubauer,

Oražem Mrak

et al. 2024

Front. Pediatr.

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“…It is convenient, effective, and does not cause respiratory depression which maximizes the benefits for the pediatric population ( 6 , 7 ). A meta-analysis revealed that intranasal dexmedetomidine was superior to traditional oral chloral hydrate and could provide better safety for imaging sedation ( 8 ). On the other hand, dexmedetomidine has the unique capability to create a neurophysiological state similar to non-rapid-eye-movement sleep.…”

Section: Introductionmentioning

confidence: 99%

Using intranasal dexmedetomidine with buccal midazolam for magnetic resonance imaging sedation in children: A single-arm prospective interventional study

Luo

Huang

et al. 2022

Front. Pediatr.

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ObjectiveAlthough numerous intravenous sedative regimens have been documented, the ideal non-parenteral sedation regimen for magnetic resonance imaging (MRI) has not been determined. This prospective, interventional study aimed to investigate the efficacy and safety of buccal midazolam in combination with intranasal dexmedetomidine in children undergoing MRI.MethodsChildren between 1 month and 10 years old requiring sedation for MRI examination were recruited to receive buccal midazolam 0.2 mg⋅kg–1 with intranasal dexmedetomidine 3 μg⋅kg–1. The primary outcome was successful sedation following the administration of the initial sedation regimens and the completion of the MRI examination.ResultsSedation with dexmedetomidine–midazolam was administered to 530 children. The successful sedation rate was 95.3% (95% confidence interval: 93.5–97.1%) with the initial sedation regimens and 97.7% (95% confidence interval: 96.5–99%) with a rescue dose of 2 μg⋅kg–1 intranasal dexmedetomidine. The median sedation onset time was 10 min, and a significant rising trend was observed in the onset time concerning age (R = 0.2491, P < 0.001). The wake-up and discharge times significantly correlated with the duration of the procedure (R = 0.323, P < 0.001 vs. R = 0.325, P < 0.001). No oxygen deficiency nor medication intervention due to cardiovascular instability was observed in any of the patients. History of a prior failed sedation was considered a statistically significant risk factor for failed sedation in the multivariate logistic regression model [odds ratio = 4.71 (95% confidence interval: 1.24–17.9), P = 0.023].ConclusionIn MRI examinations, the addition of buccal midazolam to intranasal dexmedetomidine is associated with a high success rate and a good safety profile. This non-parenteral sedation regimen can be a feasible and convenient option for short-duration MRI in children between 1 month and 10 years.

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“…Another investigations compared intranasal dexmedetomidine to oral chloral hydrate, an hypnotic sedative often administered in nurse-assisted diagnostic procedures due to its safe profile [37]. Dexmedetomidine resulted in higher procedural success rate (RR = 1.14, 95% CI 1.03 to 1.26), faster awaking (–9.75 min, 95% CI –17.57 to –1.94) and lower incidence of nausea and vomiting (RR = 0.09, 95% CI 0.04 to 0.23) than chloral hydrate.…”

Section: Nurse-assisted Sedated Magnetic Resonance Imagingmentioning

confidence: 99%

Anesthesia for pediatric magnetic resonance imaging: a review of practices and current pathways

Fonseca

Garbin

Bertolizio

2023

Current Opinion in Anaesthesiology

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Purpose of review Magnetic resonance imaging (MRI) is an ever-expanding investigation modality in children. This review aims to present current strategies to perform MRI in pediatrics efficiently and safely. The latest evidence on approaches, safety and costs of MRI with no sedation or with sedation provided by anesthesiologists and non-anesthesiologists are outlined and discussed. Recent findings MRI under sedation provided by either anesthesiologists or non-anesthesiologists has a low incidence of minor adverse events and rarely severe complications. Propofol infusion with or without dexmedetomidine appears the ideal anesthetic, as it allows spontaneous breathing and fast turnover. Intranasal dexmedetomidine is safe and the most effective medication when a nonintravenous route is employed. New scanning techniques and patient's preparation methods can increase the chances to successfully perform MRI with no sedation by shortening sequences, reducing artifacts, and improving child's cooperation. Summary MRI under sedation can be considered safe. Proper patient selection, clear decision-making and medico-legal pathways are particularly necessary for nurse-only sedated scans. Nonsedated MRIs are feasible and cost-effective but require optimal scanning techniques and patient's preparation to be successful. Further research should be focused on identifying the most effective modalities to perform MRI without sedation and clarify protocols for the nurse-only sedations. Anesthesia service will likely remain pivotal for complex and critically ill patients and to provide assistance in case of adverse events.

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Efficacy and Safety of Intranasal Dexmedetomidine vs. Oral Chloral Hydrate for Sedation in Children Undergoing Computed Tomography/Magnetic Resonance Imaging: A Meta-Analysis

Cited by 6 publications

References 29 publications

Melatonin vs. dexmedetomidine for sleep induction in children before electroencephalography

Melatonin vs. dexmedetomidine for sleep induction in children before electroencephalography

Using intranasal dexmedetomidine with buccal midazolam for magnetic resonance imaging sedation in children: A single-arm prospective interventional study

Anesthesia for pediatric magnetic resonance imaging: a review of practices and current pathways

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