Intranasal Dexmedetomidine as a Sedative for Pediatric Procedural Sedation

Abstract

OBJECTIVE This study seeks to evaluate the efficacy and safety of intranasal (IN) dexmedetomidine as a sedative medication for non-invasive procedural sedation. METHODS Subjects 6 months to 18 years of age undergoing non-invasive elective procedures were included. Dexmedetomidine (3 mcg/kg) was administered IN 40 minutes before the scheduled procedure time. The IN dexmedetomidine cohort was matched and compared to a cohort of 690 subjects who underwent sedation for similar procedures without the use of dexmedetomidine to evaluate for observed events/interventions and procedural times. RESULTS One hundred (92%) of the 109 included subjects were successfully sedated with IN dexmedetomidine. There were no significant differences in the rate of observed events/interventions in comparison to the non-dexmedetomidine cohort. However, the IN dexmedetomidine group had a longer postprocedure sleep time when compared to the non-dexmedetomidine cohort (p < 0.001), which had a significant effect on recovery time (p = 0.024). Also, the dexmedetomidine cohort had longer procedure time and total admit time (p < 0.001 and p = 0.037, respectively). CONCLUSIONS IN dexmedetomidine may be used for non-invasive pediatric procedural sedation. Subjects receiving IN dexmedetomidine had a similar rate of observed events/interventions as the subjects receiving non-dexmedetomidine sedation, with the exception of sleeping time. Also, patients sedated with IN dexmedetomidine had longer time to discharge, procedure time, and total admit time in comparison to other forms of sedation.

Does intranasal dexmedetomidine provide adequate plasma concentrations for sedation in children: a pharmacokinetic study

“…Administration of intranasal dexmedetomidine has typically been reported in doses ranging from 1 to 3 mg kg À1 . 29,30 Published pharmacodynamic data in young children sedated with intranasal dexmedetomidine from our institution and others show adequate sedation for non-painful procedures at approximately 20e30 min after administration, with duration of approximately 30e60 min. 7,10,29 We performed intranasal administration by atomisation, which has several potential advantages over simple nasal drop administration, such as uniform application throughout the nasal mucosa to maximise the area of absorption.…”

Determination of the 90% effective dose of intranasal dexmedetomidine for sedation during electroencephalography in children

“…Li BL et al reported that the first‐dose success rates were 87% for transthoracic echocardiography with a dose of 3 μg kg −1 intranasal DEX in children under the age of 3 years, and no adverse events were reported . Natalie Behrle et al found that 100 (92%) of the 109 paediatric patients were successfully sedated with 3 μg kg −1 DEX by the intranasal route in non‐invasive elective procedures . The dose of intranasal DEX in our study is close to those used in the above studies.…”

Incidence and risk factors of bradycardia in pediatric patients undergoing intranasal dexmedetomidine sedation

“…There has been a growing interest in the application of intranasal dexmedetomidine as sedative medication for non-invasive procedural sedation in pediatric patients. 2 Intranasal administration of dexmedetomidine offers the advantages of low risk of post-procedure nasal irritation, nausea, and vomiting. 3 Moreover, intranasal dexmedetomidine was shown to be associated with a lower incidence of hemodynamic instability and respiratory depression when compared with intravenous route.…”