Fifty Percent Effective Dose of Intranasal Dexmedetomidine Sedation for Transthoracic Echocardiography in Children With Cyanotic and Acyanotic Congenital Heart Disease

Intranasal dexmedetomidine for transthoracic echocardiography in infants with shunt-dependent single ventricle heart disease

“…While intranasal dexmedetomidine has emerged as an attractive option for procedural sedation in paediatrics, the downside to intranasal dexmedetomidine use includes dose-dependent hypotension and bradycardia that may limit its use amongst interstage infants who have a potentially unstable circulation. [20][21] Doses of 1.5-4 mcg/kg/dose intranasal dexmedetomidine have been described for procedural sedation with higher doses resulting in longer duration of adequate sedation. [20][21]27 Based on institutional experience, our practice was to administer 3 mcg/kg as an initial dose of intranasal dexmedetomidine with an adjunct 1 mcg/kg/dose if not sedated after 25 minutes.…”

“…Prior investigations do suggest that when selecting intranasal dexmedetomidine dose for echo sedation, consideration for cyanotic CHD is important as the effective dose for sedation is higher in children with cyanotic CHD. 18,[20][21] Our study did not investigate different dosing strategies for sedation in interstage infants nor the intranasal dexmedetomidine dose-response relationship since our target was achieving sedation. Also, our study did not establish an objective sedation scale which is a consideration for future studies.…”

DEX Marks the Spot: Finding the Optimal Sedation Regimen for Pediatric Patients Undergoing Sedated Transthoracic Echocardiography

“…Intranasal DEX when used as a single agent for sedated TTE has been studied by various groups, with doses ranging between 1.9 mg/kg and 3.2 mg/ kg. 5,8 Side effects from these studies included bradycardia and hypotension, which occurred independent of the dose of DEX. 4,8 Conversely, ketamine, an NMDA antagonist can cause hypertension and tachycardia.…”

“…Several anesthesia regimens have been under investigation for the pediatric CHD population, including oral pentobarbital, intranasal DEX, and combinations of intranasal DEX with oral or intranasal KET. 3,[5][6][7] Each agent carries inherent risks of side effects and hemodynamic derangements. As previously demonstrated, DEX, an alpha 2 agonist with sedative and mild analgesic properties has been shown to cause hypotension and bradycardia.…”

“…Additionally, the effective dose of medications, specifically DEX has been shown to differ between patients with cyanotic versus acyanotic heart disease, with a higher requirement in patients with cyanotic disease. 5 Inclusion of this patient population potentially would alter the results of the study.…”