Intramuscular dexmedetomidine and oral chloral hydrate for pediatric sedation for electroencephalography: A propensity score‐matched analysis

Abstract

Background Intramuscular dexmedetomidine can be used for pediatric sedation without requiring intravenous access and has advantages for electroencephalography by inducing natural sleep pathway, but only a limited number of studies compared the efficacy of intramuscular dexmedetomidine with oral chloral hydrate. Aims To compare the efficacy and safety of intramuscular dexmedetomidine and oral chloral hydrate used for sedation during electroencephalography in pediatric patients. Methods We reviewed the medical records of pediatric patients who underwent sedation for electroencephalography between January 2015 and December 2016. Initial doses of dexmedetomidine and chloral hydrate were 3 mcg/kg and 50 mg/kg, respectively; second doses (1 mcg/kg and 50 mg/kg, respectively) were administered if adequate sedation was not achieved. Demographic data, time of sedative administration, time of sedation and awakening, and time of arrival at recovery room and discharge were analyzed. Results Out of a total of 1239 patients, 125 patients had received dexmedetomidine and 1114 had received chloral hydrate. After 1:1 propensity score matching, the dexmedetomidine and chloral hydrate groups each had 118 patients. Testing completion rate with a single dose of medication was higher in the dexmedetomidine group (91.5% vs 71.2%; mean difference [95% CI] 20.3 [10.8‐29.9]; P < .0001; Pearson chi‐square value = 16.09). Sedation onset time was shorter in the dexmedetomidine group as well (16.6 ± 13.0 minutes vs 41.5 ± 26.8 minutes; mean difference [95% CI] 24.8 [19.1‐30.6]; P < .0001; T = 8.27). On the contrary, the duration of recovery was longer in the dexmedetomidine group (35.5 ± 40.2 minutes vs 18.5 ± 30.7 minutes; mean difference [95% CI] 18.6 [8.8‐28.5]; P = .0002; T = −2.82). Total residence time was not significantly different between the two groups (125.8 ± 40.6 minutes vs 122.1 ± 42.2 minutes, mean difference [95% CI] 5.21 [6.1‐16.5], P = .3665 T = 0.04). Conclusions Intramuscular dexmedetomidine showed higher sedation success rate and shorter time to achieving the desired sedation level compared with oral chloral hydrate and thus may be an effective alternative for oral chloral hydrate in pediatric patients requiring sedation for electroencephalography.

Efficacy and Safety of Intranasal Dexmedetomidine versus Oral Chloral Hydrate as Sedatives for Pediatric Patients: A Systematic Review and Meta-Analysis

“…Sixtyseven articles were further analyzed, and 53 were excluded based on the inclusion and exclusion criteria. Finally, 14 studies [11][12][13][14][15][16][17][18][19][20][21][22][23][24] with a total of 3749 pediatric participants were included in the meta-analysis. The selection process is presented in figure 1, and the basic information of the included studies is summarized in online supplemental table 1.…”

Recent Advances in the Clinical Value and Potential of Dexmedetomidine

“…Recent research noted that Intramuscular dexmedetomidine exhibits a higher sedation success rate and shorter time to achieve the desired sedation level compared with oral chloral hydrate; thus, it may be an effective alternative for oral chloral hydrate in pediatric patients requiring sedation for electroencephalography. 45 Children with autism spectrum disorders requiring procedural sedation may represent a challenge for pediatricians and anesthesiologists in the emergency setting due to limited communication and poorly predictable behavioral skills. Interestingly, a case series report of children with autism spectrum disorders treated with intramuscular dexmedetomidine to perform urgent painless diagnostic procedures in various health facilities indicates that this route of administration is feasible for these special children needing urgent procedural sedation.…”

The Safety and Efficacy Evaluation of Dexmedetomidine for Procedural Sedation and Postoperative Behaviors in Pediatric Populations: A Systematic Review and Meta-analysis

“…19 Although dexmedetomidine is not indicated for use in pediatrics, its application in sedation in children has been greatly increased because of its advantages such as relatively preserved airway tone and respiratory drive. 20,21 In cardiac surgery, dexmedetomidine has been successfully used for sedation and analgesia in the pediatric ICU after cardiac surgery. 6 A recent report describes the pharmacokinetic profile of intravenous dexmedetomidine in 12 pediatric patients undergoing cardiac surgery after 1 or 2 µg/kg/1 h intravenous dexmedetomidine dose for the first 2 hours, and the pediatric patient was sedated 10 to 33 minutes after the 2-to 3/µg/kg/1 dexmedetomidine dose.…”

“…We evaluated the quality of the literature and selected high-quality literature as the inclusion criteria for research. [6][7][8][11][12][13]20,[26][27][28][29][30][31][32]…”