Outcomes of a nurse practitioner-led, intravenous dexmedetomidine-based pediatric sedation program for Magnetic Resonance Imaging in a general hospital.  A prospective observational study.

Abstract

Purpose Prospective observational study on the effectiveness and safety of a nurse practitioner-led pediatric sedation program for Magnetic Resonance Imaging (MRI) with intravenous dexmedetomidine in a Dutch general hospital. Methods 115 children, aged 6 months to 11 years, scheduled for MRI, underwent 119 sedations with an intravenous (IV)-loading dose dexmedetomidine (3μgr/kg) followed by continuous infusion (2 μgr/kg/h). Great emphasis was put on non-pharmacological strategies to create a quiet environment and to reduce patients’ anxiety. The observed outcomes were sedation time, recovery time, Ramsay Sedation Scores (RSS), sedation failure and adverse events. Results Median sedation time was 52 minutes (range 27-148 minutes). Median recovery time was 82 minutes (range 5-177 minutes). Deepest individual RSS ranged from 4 to 6 (11,8% deepest RSS 4, 69,3% deepest RSS 5, 18,8% deepest RSS 6). All sedations (100%) were successful. One patient (0,8%), experienced a brief episode of oxygen desaturation as low as 90%, rapidly resolving after low-flow oxygen therapy. Two patients (1,6%), experienced an episode of mild hypotension respectively during and immediately after dexmedetomidine administration. Both quickly normalized after a fluid bolus. One patient (0,8%) experienced post-sedation nausea. Conclusions Sedation with intravenous dexmedetomidine for MRI can be safely and effectively entrusted to a competent nurse practitioner-led pediatric sedation team. To achieve high success rates, mastering the typical sedative characteristics of dexmedetomidine is essential, including the application of optimal logistics, consistent use of non-pharmacological comfort strategies and an effective, goal-directed collaboration between all involved.