Factors affecting successful use of intranasal dexmedetomidine: a cohort study from a national paediatrics tertiary centre

Abstract

Background: Use of intranasal (IN) dexmedetomidine for procedural sedation has been reported in recent years. Good patient selection is important to ensure high success rates. We aimed to identify factors that influence the successful use of IN dexmedetomidine in non-invasive investigations. Methods: All paediatric patients who received IN dexmedetomidine for investigations between 01 July 2019 to 01 July 2020 were included. Baseline demographics, time to reach adequate sedation level, duration of sedation, dose, indications for sedation and need for rescue sedatives were recorded. Procedures were classified into "long" or "short" according to completion time. Successful sedation was defined by completion of investigations by IN dexmedetomidine alone. Results: Of 105 patients included, median age was 20.0 months, and median weight 11.0 kg. Magnetic resonance imaging (56, 53.3%) was the most common indication. Sixty (57.1%) were successfully sedated using IN dexmedetomidine alone. Automated auditory brainstem response, computerised tomography and mercaptoacetyltriglycine-3 renogram scans had the highest success rate (83.3%, 83.3%, and 100% respectively). On multivariate analysis, short procedures had an adjusted odds ratio of 5.30 (95% CI: 1.69-16.61; P=0.004) compared to long procedures.Conclusions: IN dexmedetomidine is effective for procedural sedation for paediatric patients. The most important predictor for sedation success was indication of sedation and duration of procedures.

Sedation with Intranasal Dexmedetomidine in the Pediatric Population for Auditory Brainstem Response Testing: Review of the Existing Literature

“…The studies were quite homogenous in terms of the administered dose, most of the authors used 3 μg/kg to induce sleep. Fan et al [ 12 ], using this dosage, reported adequate sedation for ABR but noted significant differences in weight and age between babies who were adequately sedated by IN DEX only and the ones who did not; however, adequate sedation was obtained more frequently in ABR than other procedures investigated in this study, suggesting the IN DEX to be particularly suitable for this use case. A single dose appears to be sufficient to achieve sedation in the majority of cases, and multiple administrations can be given, if necessary, without adverse effects; the maximum dosage more often reported is 100 μg.…”

“…Reynolds [ 20 ] showed a high number of satisfactory sedation from a single dose (89%); the same author in a prospective and randomized study [ 6 ], showed the ability to complete ABR examination with one sedative dose was 91%. Similarly, Baier et al [ 19 ] found a 90% success rate by the first dose, Godbehere et al [ 4 ] identified a 100% success rate, and Fan et al [ 12 ] reported 83% sedation success. Conversely, Li et al [ 21 ] described a lower success rate (64.3%) compared with the results of other authors.…”

“…Six full-text articles were identified [ 4 , 6 , 12 , 19 , 20 , 21 ] ( Table 2 ); we identified three retrospective works, two double-blind randomized controlled trials, and one prospective no-randomized work. Three studies were conducted in the United States of America, one in China, one in Singapore, and one in the United Kingdom.…”

“…The advantage of Dexmedetomidine (DEX) appears to be its stronger safety profile, including the lack of negative respiratory effects [ 4 ]. It can be administered intravenously, but the intranasal (IN) route is also an option, with the advantage of avoiding the stress and pain associated with IV catheter insertion in a non-cooperative patient [ 11 , 12 ].…”

“…Systematic reviews have also been written on the topic of procedural sedation with IN DEX [ 7 , 16 , 17 ]. However, no literature review has been produced about its specific utilization in ABR testing; while being a reasonable option, this use case remains sparse and probably overlooked, with the absence of a clear standard protocol [ 12 ].…”