Intranasal Dexmedetomidine for Sedation for Pediatric Computed Tomography Imaging

et al. 2018

Summary Background Intranasal procedural sedation using dexmedetomidine is well described in the literature. The combination of intranasal dexmedetomidine and ketamine is a novel approach for which there are little data on the rate of successful sedation or adverse events. Objectives The aim of this study is to evaluate the rate of successful sedation and adverse events of intranasal procedural sedation using a combination of dexmedetomidine and ketamine for diagnostic examination in children. Methods This was a retrospective study and data were collected after ethics approval. A total of 17 948 pediatric patients (7718 females, 10 230 males) in a tertiary hospital in China were evaluated. Patients received a combination of 2 μg kg−1 of dexmedetomidine and 1 mg kg−1 of ketamine intranasally for procedural sedation. The level of sedation and recovery was assessed by the Modified Observer Assessment of Alertness/Sedation scale and the Modified Aldrete Score. Results The rate of intranasal sedation success was 93% (16691/17948), intranasal sedation rescue was 1.8% (322/17948), and intranasal sedation failure was 5.2% (935/17948). Sedation success was defined as successful completed the diagnostic examination and obtained adequate diagnostic‐quality images and reports. Intranasal sedation success, rescue and failure were respectively defined as sedation success with intranasal a single dose, additional bolus dose and the need for intravenous (IV) medications/inhalation agents. Median sedation time was 62 min (interquartile range: 55‐70 min), median time for onset of sedation was 15 min (interquartile range: 15‐20 min), and median sedation recovery time was 45 min (interquartile range: 38‐53 min). Incidence of adverse events was low (0.58%; 105/17948), with major and minor adverse event being reported in 0.02% (4/17948) and 0.56% (101/17948) patients, respectively. Postoperative nausea and vomiting was the most common (0.3%; 53/17948) minor adverse event. Conclusion Procedural sedation using a combination of intranasal dexmedetomidine and ketamine is associated with acceptable effectiveness and low rates of adverse events.

Section: Discussioncontrasting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Analysis of 17 948 pediatric patients undergoing procedural sedation with a combination of intranasal dexmedetomidine and ketamine

Yang

et al. 2018

“…Compared to a lower dose, 2 μg kg −1 are more efficient at producing sedation and less cardiovascular variability . Other studies used an initial dose of intranasal dexmedetomidine 2.5‐3.0 μg kg −1 to achieve successful sedation …”

Section: Discussionmentioning

confidence: 98%

“…Intranasal dexmedetomidine has been use to diverse sedation in doses ranging 1‐3 μg kg −1. Clinical trials by Yuen have demonstrated that intranasal dexmedetomidine in a dose of 1 μg kg −1 produced satisfactory sedation in between 53% and 57% of children . There are also report using higher doses of intranasal dexmedetomidine.…”

Section: Discussionmentioning

confidence: 99%

Median effective dose of intranasal dexmedetomidine sedation for transthoracic echocardiography in pediatric patients with noncyanotic congenital heart disease: An up‐and‐down sequential allocation trial

Sun

et al. 2017

“…Dexmedetomidine, a highly selective and potent α 2 ‐adrenoceptor agonist, acts on α 2‐ adrenoceptors in the locus coeruleus of the brainstem to exert good sedative/anxiolytic effects that are similar to those of natural sleep . Intranasal dexmedetomidine exhibits good sedative effects in both adults and children with no central respiratory repression; the bioavailability is as high as 82%, and no injury on the nasal nerves has been reported . However, there are some disadvantages of dexmedetomidine when it is used alone.…”

Section: Discussionmentioning

confidence: 99%

Sedation effects of intranasal dexmedetomidine combined with ketamine and risk factors for sedation failure in young children during transthoracic echocardiography

et al. 2018

Summary Background Sedation is often required for young children during transthoracic echocardiography. Dexmedetomidine and ketamine are two sedatives that are commonly used in children for procedural sedation, but they have some disadvantages when they are used alone. Aims The aim of this retrospective study was to analyze the effects and safety of intranasal sedation with a combination of dexmedetomidine and ketamine during transthoracic echocardiography in young children and to analyze risk factors for sedation failure. Methods After IRB approval, we retrospectively evaluated data on patients who underwent echocardiography between May 2016 and August 2017 utilizing a combination of dexmedetomidine 2 μg/kg and ketamine 1 mg/kg. We collected information including heart rate, pulse oxygen saturation, sedation onset time, exam time, recovery time, and adverse reactions. Stepwise logistic regression analyses were performed to analyze the risk factors for sedation failure. Results Sedation was successful in 2212 patients (96%) and took effect in 15.7 (IQR: 10‐23) min, while sedation failed in 92 patients. Cyanotic heart disease, history of sedation failure, history of congenital heart disease surgery, and fever were independent risk factors for sedation failure. Most of the patients in this study had an American Society of Anesthesiologists (ASA) grade of II to III, but no severe adverse reactions were observed. Conclusion Intranasal sedation with a combination of dexmedetomidine and ketamine is effective and appears to have an acceptable safety profile for young children during transthoracic echocardiography.