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

Yu, Qian; Liu, Yang; Sun, Mei; Zhang, Jing; Zhao, Yan; Liu, Fengzhi; Li, Shangyingying; Tu, Shengfen

doi:10.1111/pan.13235

Cited by 22 publications

(20 citation statements)

References 33 publications

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“…A recent study have found that 90% of the effective dose of intranasal DEX sedation was 3.28 μg•kg − 1 in children [23]. Another study found that the 50% effective dose and the 95% effective dose of intranasal DEX increased with increasing age in patients under 3 years of age [24]. The success rate of sedation in our study was slightly lower than that in previous studies [11].…”

Section: Discussioncontrasting

confidence: 71%

Intranasal dexmedetomidine is an effective sedative agent for electroencephalography in children

Chen

Yang

et al. 2020

BMC Anesthesiol

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Background: Intranasal dexmedetomidine (DEX), as a novel sedation method, has been used in many clinical examinations of infants and children. However, the safety and efficacy of this method for electroencephalography (EEG) in children is limited. In this study, we performed a large-scale clinical case analysis of patients who received this sedation method. The purpose of this study was to evaluate the safety and efficacy of intranasal DEX for sedation in children during EEG. Methods: This was a retrospective study. The inclusion criteria were children who underwent EEG from October 2016 to October 2018 at the Children's Hospital affiliated with Chongqing Medical University. All the children received 2.5 μg•kg − 1 of intranasal DEX for sedation during the procedure. We used the Modified Observer Assessment of Alertness/Sedation Scale (MOAA/S) and the Modified Aldrete score (MAS) to evaluate the effects of the treatment on sedation and resuscitation. The sex, age, weight, American Society of Anesthesiologists physical status (ASAPS), vital signs, sedation onset and recovery times, sedation success rate, and adverse patient events were recorded. Results: A total of 3475 cases were collected and analysed in this study. The success rate of the initial dose was 87.0% (3024/3475 cases), and the success rate of intranasal sedation rescue was 60.8% (274/451 cases). The median sedation onset time was 19 mins (IQR: 17-22 min), and the sedation recovery time was 41 mins (IQR: 36-47 min). The total incidence of adverse events was 0.95% (33/3475 cases), and no serious adverse events occurred. Conclusions: Intranasal DEX (2.5 μg•kg − 1) can be safely and effectively used for EEG sedation in children.

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Section: Discussioncontrasting

confidence: 71%

Intranasal dexmedetomidine is an effective sedative agent for electroencephalography in children

Chen

Yang

et al. 2020

BMC Anesthesiol

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“…So far, most of the studies examining the effective dose of intranasal DEX for sedation have used the Dixon up‐and‐down sequential method . The purpose of those studies was to determine the 50% effective doses.…”

Section: Discussionmentioning

confidence: 99%

“…Second, we studied children under the age of 3 years old but did not specifically segment the age group. A recent study in children with noncyanotic cardiac disease who underwent transthoracic echocardiography demonstrated that the median effective dose of intranasal DEX in children aged 13‐36 months was higher than that in children aged 1‐6 or 7‐12 months …”

Section: Discussionmentioning

confidence: 99%

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

Liu

Sun

Zhang

et al. 2019

Acta Anaesthesiol Scand

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EEG is a valuable diagnostic tool for children with epilepsy, delirium and other central nervous system lesions. Children likely experience difficulty falling asleep when they are scheduled to undergo EEG. Therefore, sedation is very important.Sedation for EEG in uncooperative children remains controversial because most anaesthetics and sedatives have some effect on brain waves. Many sedative medications, such as chloral hydrate, hydroxyzine and dexmedetomidine (DEX), have been used in children undergoing EEG. Chloral hydrate is a commonly used sedative in EEG. However, previous studies have shown that chloral hydrate for sedation has a high failure rate of 27% in patients with abnormal behaviour, 1,2 it may increase fast EEG activity, and it has side effects, including respiratory depression, 3 apnoea, airway obstruction, hypoxia, hypotension and hypercarbia. 4 DEX is a highly selective alpha-2 adrenergic agonist that functions as a sedative and an analgesic. DEX has been studied as a suitable sedative agent for children undergoing many procedures, as it has a low risk of side effects and a short half-life. DEX can cause EEG patterns similar to those of sleep stage II with modest increases in θ, α and β activity and has no effect on EEG epileptic activity in children, which makes it a suitable Background: The intranasal route of dexmedetomidine (DEX) administration is becoming increasingly popular for providing adequate sedation during short examinations in infants and children. However, data on the 90% effective dose (ED90) of intranasal DEX are rare in children under 3 years old.Methods: This is a double-blind trial using a biased coin design up-and-down sequential method (BCD-UDM). Fifty-three children aged under 3 years old requiring DEX for EEG were included in our study. The first patient received 2.5 μg kg −1 DEX, and the dose of DEX administered to the subsequent patient was determined by the response of the previous patient. The patient responses were recorded and analysed to calculate the ED90 by isotonic regression. The 95% confidence interval (CI) was estimated using a bootstrapping method.Results: Fifty-three patients were included in our study, of which 45 patients were successfully sedated, and the 8 instances of failed sedation were rescued using sevoflurane inhalation, allowing the completion of the procedure. The 90% effective dose of DEX was calculated to be 3.28 µg kg −1 , and the 95% CI was 2.74 ~ 3.39 µg kg −1 .No significant adverse events occurred in any of the patients. Conclusion:The 90% effective dose of intranasal DEX sedation for EEG was 3.28 μg kg −1 in children under 3 years old.

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“…However, sedation practices differ among paediatric cardiac centres, as chloral hydrate, midazolam, pentobarbital, dexmedetomidine, ketamine, or propofol are used for this purpose. 1,[3][4][5][18][19][20] Also, administration routes differ such as oral, intranasal, rectal, or intramuscular [3][4][5][6][18][19][20] as well as dosage. [5][6][7]15 In a previous study, researchers reported that onset of sedation was not significantly different between midazolam and chloral hydrate groups, but they found significantly shorter recovery time in the midazolam group.…”

Section: Discussionmentioning

confidence: 99%

Comparison of intranasal midazolam, intranasal ketamine, and oral chloral hydrate for conscious sedation during paediatric echocardiography: results of a prospective randomised study

Alp¹,

Elmacı²,

Esma³

et al. 2019

Cardiol Young

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Objective:There are several agents used for conscious sedation by various routes in children. The aim of this prospective randomised study is to compare the effectiveness of three commonly used sedatives: intranasal ketamine, intranasal midazolam, and oral chloral hydrate for children undergoing transthoracic echocardiography.Methods:Children who were referred to paediatric cardiology due to a heart murmur for transthoracic echocardiography were prospectively randomised into three groups. Seventy-three children received intranasal midazolam (0.2 mg/kg), 72 children received intranasal ketamine (4 mg/kg), and 72 children received oral chloral hydrate (50 mg/kg) for conscious sedation. The effects of three agents were evaluated in terms of intensity, onset, and duration of sedation. Obtaining high-quality transthoracic echocardiography images (i.e. absence of artefacts) were regarded as successful sedation. Side effects due to medications were also noted.Results:There was no statistical difference in terms of sedation success rates between three groups (95.9, 95.9, and 94.5%, respectively). The median onset of sedation in the midazolam, ketamine, and chloral hydrate was 14 minutes (range 7–65), 34 minutes (range 12–56), and 40 minutes (range 25–57), respectively (p < 0.001 for all). However, the median duration of sedation in study groups was 68 minutes (range 20–75), 55 minutes (range 25–75), and 61 minutes (range 34–78), respectively (p = 0.023, 0.712, and 0.045). Gastrointestinal side effects such as nausea and vomiting were significantly higher in the chloral hydrate group (11.7 versus 0% for midazolam and 2.8% for ketamine, respectively, p = 0.002).Conclusion:Results of our prospectively randomised study indicate that all three agents provide adequate sedation for successful transthoracic echocardiography. When compared the three sedatives, intranasal midazolam has a more rapid onset of sedation while intranasal ketamine has a shorter duration of sedation. Intranasal ketamine can be used safely with fewer side effects in children undergoing transthoracic echocardiography.

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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

Cited by 22 publications

References 33 publications

Intranasal dexmedetomidine is an effective sedative agent for electroencephalography in children

Intranasal dexmedetomidine is an effective sedative agent for electroencephalography in children

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

Comparison of intranasal midazolam, intranasal ketamine, and oral chloral hydrate for conscious sedation during paediatric echocardiography: results of a prospective randomised study

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