Intranasal Dexmedetomidine for Procedural Distress in Children: A Systematic Review

Poonai, Naveen; Spohn, Joseph; Vandermeer, Ben; Ali, Samina; Bhatt, Maala; Hendrikx, Shawn; Trottier, Evelyne D; Sabhaney, Vikram; Shah, Amit; Joubert, Gary; Hartling, Lisa

doi:10.1542/peds.2019-1623

Cited by 44 publications

(51 citation statements)

References 65 publications

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“…Third, although the results of the present study together with previous study (42) indicated the efficacy and safety of intranasal dexmedetomidine administration during breast lumpectomy, future studies need to be conducted to focus on the safety in a larger sample size. Fourth, individual differences in drug tolerance may also provide bias since the time point for surgery was 45 min after intranasal dexmedetomidine was selected according to previous studies (14,(28)(29) instead of plasma concentration.…”

Section: Discussionmentioning

confidence: 99%

“…Local anesthesia may be an alternative to general anesthesia for this type of surgery ( 5 ). Dexmedetomidine is an effective drug for conscious sedation in patients who undergo minor surgery ( 14 , 17 , 30 , 31 ). A previous study demonstrated that intranasal dexmedetomidine was noninvasive and more tolerable compared with intravenous administration ( 14 ).…”

Section: Discussionmentioning

confidence: 99%

“…Dexmedetomidine is an effective drug for conscious sedation in patients who undergo minor surgery ( 14 , 17 , 30 , 31 ). A previous study demonstrated that intranasal dexmedetomidine was noninvasive and more tolerable compared with intravenous administration ( 14 ). In addition, the intranasal route is safe, effective, comfortable and convenient ( 14 , 22 , 32 – 34 ).…”

Section: Discussionmentioning

confidence: 99%

“…A previous study demonstrated that intranasal dexmedetomidine was noninvasive and more tolerable compared with intravenous administration ( 14 ). In addition, the intranasal route is safe, effective, comfortable and convenient ( 14 , 22 , 32 – 34 ). Iirola et al ( 28 ) demonstrated that administration of intranasal dexmedetomidine had a high bioavailability of 65% (35-93%) and could potentially have useful sedative effects in surgical procedures.…”

Section: Discussionmentioning

confidence: 99%

“…Dexmedetomidine is a highly selective α 2 -adrenoreceptor agonist that induces sedation providing improved hemodynamic stability without eliciting respiratory depression ( 10 – 13 ). Previous studies have reported that dexmedetomidine is rapidly and efficiently absorbed after intranasal administration, and is better tolerated compared with intravenous administration ( 14 – 17 ). Additionally, intranasal dexmedetomidine has been successfully used for conscious sedation under local anesthesia in numerous minor surgeries, including neurotologic procedures and dental surgery ( 18 – 20 ).…”

Section: Introductionmentioning

confidence: 99%

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Intranasal dexmedetomidine combined with local anesthesia for conscious sedation during breast lumpectomy: A prospective randomized trial

et al. 2020

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Breast lumpectomy is usually performed under general or local anesthesia. To the best of our knowledge, whether conscious sedation with intranasal dexmedetomidine and local anesthesia is an effective anesthetic technique has not been studied. Thus, the present study aimed to investigate the effectiveness of conscious sedation with intranasal dexmedetomidine combined with local anesthesia in breast lumpectomy, and to identify its optimal dose. A prospective randomized, double-blinded, placebo-controlled, single-center study was designed, and patients undergoing breast lumpectomies were recruited based on the inclusion and exclusion criteria. All patients were randomly allocated to four groups: i) Local anesthesia with 0.9% intranasal saline (placebo); local anesthesia with ii) 1 µg.kg-1 ; iii) 1.5 µg.kg-1 ; or iv) 2 µg.kg-1 intranasal dexmedetomidine. The sedation status, pain relief, vital signs, adverse events, and satisfaction of patient and surgeon were recorded. Patients in the three dexmedetomidine groups were significantly more sedated and experienced less pain compared with the placebo group 45 min after intranasal dexmedetomidine administration and during 30 min in the post-anesthesia care unit. Patients in the 1.5 µg.kg-1 group were more sedated compared with the 1 µg.kg-1 group (without reaching statistical significance), whereas the 1.5 µg.kg-1 group exhibited a similar level of sedation 45 min after intranasal dexmedetomidine administration compared with the 2 µg.kg-1 group. In addition, patients in the 1 and 1.5 µg.kg-1 group experienced no adverse hemodynamic effects. Patient and surgeon satisfaction were greater in the 1.5 µg.kg-1 group compared with the 1 and 2 µg.kg-1 groups. Taken together, the results of the present study suggested that conscious sedation with intranasal dexmedetomidine and local anesthesia may be an effective anesthetic for breast lumpectomy surgery, and that the optimal dose for intranasal dexmedetomidine administration may be 1.5 µg.kg-1 , as it resulted in good sedation and patient satisfaction without adverse effects.

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