Pediatric Procedural Sedation Using Dexmedetomidine: A Report From the Pediatric Sedation Research Consortium

Sulton, Carmen; McCracken, Courtney; Simon, Harold K.; Hebbar, Kiran; Reynolds, Jason; Cravero, Joseph P.; Mallory, Michael D.; Kamat, Pradip

doi:10.1542/hpeds.2015-0280

Cited by 79 publications

(37 citation statements)

References 31 publications

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“…Results from our study demonstrate that over 99.7% of procedures were completed using ketamine + propofol. Although the overall SAE rate was low (3.47%), it was higher compared with the use of propofol alone (2.21%) or with the use of ketamine alone (1.77%) for PS reported in previous PSRC studies (15, 17). Among the SAEs in the ketamine + propofol combination group from this study, we found a higher percentage of airway obstruction, emergent airway intervention, unplanned admission, and emergency anesthesia consultation compared with what is reported in previous PSRC studies on propofol alone (SAE 2.21% and 2.28% for references [15] and [161, respectively) (15, 16, 20).…”

Section: Discussionmentioning

confidence: 57%

“…Previously, the PSRC database has been used to report on the demographics, success, and adverse sedation-related events associated with a variety of PS medication regimens (3,5,15–17). We used the PSRC database to describe the patient, procedure, and sedation regimen characteristics, adverse event (AE) profile, and risk factors associated with increased odds of AEs or serious AEs (SAEs) in a subcohort of patients receiving the combination of ketamine + propofol for PS.…”

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confidence: 99%

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Pediatric Procedural Sedation Using the Combination of Ketamine and Propofol Outside of the Emergency Department: A Report From the Pediatric Sedation Research Consortium

Grunwell

Travers

Stormorken

et al. 2017

Pediatric Critical Care Medicine

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Objectives: Outcomes associated with a sedative regimen com prised ketamine + propofol for pediatric procedural sedation outside of both the pediatric emergency department and operating room are underreported. We used the Pediatric Sedation Research Consortium database to describe a multicenter experience with ketamine + propofol by pediatric sedation providers. Design: Prospective observational study of children receiving IV ketamine + propofol for procedural sedation outside of the operating room and emergency department using data abstracted from the Pediatric Sedation Research Consortium during 2007–2015. Setting: Procedural sedation services from academic, community, free-standing children’s hospitals, and pediatric wards within general hospitals. Patients: Children from birth to less than or equal to 21 years old. Interventions: None. Measurements and Main Results: A total of 7,313 pediatric procedural sedations were performed using IV ketamine + propofol as the primary sedative regimen. Median age was 84 months (range, < 1 mo to < 21 yr; interquartile range, 36–144); 80.6% were American Society of Anesthesiologists-Physical Status less than III. The majority of sedation was performed in dedicated sedation or radiology units (76.1%). Procedures were successfully completed in 99.8% of patients. Anticholinergics (glycopyrrolate and atropine) or benzodiazepines (midazolam and lorazepam) were used in 14.2% and 41.3%, respectively. The overall adverse event and serious adverse event rates were 9.79% (95% Cl, 9.12–10.49%) and 3.47% (95% Cl, 3.07–3.92%), respectively. No deaths occurred. Risk factors associated with an increase in odds of adverse event included ASA status greater than or equal to III, dental suite, cardiac catheterization laboratory or radiology/sedation suite location, a primary diagnosis of having a gastrointestinal illness, and the coadministration of an anticholinergic. Conclusions: Using Pediatric Sedation Research Consortium data, we describe the diverse use of IV ketamine + propofol for procedural sedation in the largest reported cohort of children to date. Data from this study may be used to design sufficiently powered prospective randomized, double-blind studies comparing outcomes of sedation between commonly administered sedative and analgesic medication regimens.

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Section: Discussionmentioning

confidence: 57%

mentioning

confidence: 99%

Pediatric Procedural Sedation Using the Combination of Ketamine and Propofol Outside of the Emergency Department: A Report From the Pediatric Sedation Research Consortium

Grunwell

Travers

Stormorken

et al. 2017

Pediatric Critical Care Medicine

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“…A report on a large series of pediatric propofol sedation/anesthesia for procedures outside the operating room by the Paediatric Sedation Consortium revealed that the incidence of central apnea/airway obstruction was 575 per 10 000 propofol sedation, and the incidence of desaturation to <90% was 154 per 10 000 sedation . The Paediatric Sedation Consortium also reported the incidence of airway obstruction using dexmedetomidine was 27.7 per 10 000 sedation . In this report, dexmedetomidine was used concurrently with other sedatives.…”

Section: Discussionmentioning

confidence: 79%

“…15 The Paediatric Sedation Consortium also reported the incidence of airway obstruction using dexmedetomidine was 27.7 per 10 000 sedation. 16 In this report, dexmedetomidine was used concurrently with other sedatives.…”

Section: Discussionmentioning

confidence: 99%

A randomized controlled trial of oral chloral hydrate vs intranasal dexmedetomidine plus buccal midazolam for auditory brainstem response testing in children

Yuen

Zhou

et al. 2018

Pediatric Anesthesia

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Summary Background Moderate to deep sedation is required for an auditory brainstem response test when high‐intensity stimulation is used. Chloral hydrate is the most commonly used sedative, whereas intranasal dexmedetomidine is increasingly used in pediatric non‐painful procedural sedations. Objective The aim of this study was to compare the sedation success rate after oral chloral hydrate at 50 mg kg−1 and intranasal dexmedetomidine at 3 μg kg−1 plus buccal midazolam at 0.1 mg kg−1 for an auditory brainstem response test. Methods Children who required an auditory brainstem response test were recruited and randomly assigned to receive oral chloral hydrate at 50 mg kg−1 and intranasal placebo, or intranasal dexmedetomidine at 3 μg kg−1 with buccal midazolam 0.1 mg kg−1. The primary outcome was the rate of successful sedation for auditory brainstem response tests. Results Fifty‐seven out of 82 (69.5%) were successfully sedated after chloral hydrate, while 70 out of 78 (89.7%) children were successfully sedated with dexmedetomidine plus midazolam combination, with the odd ratio (95% CI) for successful sedation between dexmedetomidine plus midazolam combination and chloral hydrate estimated to be 3.84 (1.61‐9.16), P = 0.002. Dexmedetomidine plus midazolam was associated with quicker onset with median onset time 15 (IQR 11.0‐19.8) for dexmedetomidine plus midazolam and 20 (IQR 15.0‐27.0) for chloral hydrate respectively, with difference between median (95% CI) of 5 [3‐8], P < 0.0001). The behavior observed during drug administration of intranasal dexmedetomidine and buccal midazolam was better that of the children who had oral chloral hydrate. No children required oxygen therapy or medical intervention for hemodynamic disturbances in this study and the incidence of hypotension and bradycardia was similar. Conclusion Intranasal dexmedetomidine plus buccal midazolam was associated with higher sedation success with deeper level of sedation, with similar discharge time and adverse event rate when compared to chloral hydrate.

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“…Interestingly no opioids, barbiturates or any sedative infusions were utilized in this study. The use of a single bolus rather than an infusion of the sedative could also explain the lower success rate compared to studies that utilize propofol or ketamine which report much higher procedure success rates 15,16 . It is possible that due to the fear attributed to ketamine's side effect profile especially laryngospasm, the paediatricians were reluctant to use that as a first line agent for non-radiology procedures 17,18 .…”

Section: Discussionmentioning

confidence: 99%

Paediatric procedural sedation at a tertiary care university teaching hospital in India

Dubhashi

Silveira

Hebbar

et al. 2018

Sri Lanka J Child Health

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Pediatric Procedural Sedation Using Dexmedetomidine: A Report From the Pediatric Sedation Research Consortium

Abstract: We report the largest series of PPS using DEX outside the operating room. Within the PSRC, PPS performed using DEX has a very high success rate and is unlikely to yield a high rate of SAEs.

Cited by 79 publications

References 31 publications

Pediatric Procedural Sedation Using the Combination of Ketamine and Propofol Outside of the Emergency Department: A Report From the Pediatric Sedation Research Consortium

Pediatric Procedural Sedation Using the Combination of Ketamine and Propofol Outside of the Emergency Department: A Report From the Pediatric Sedation Research Consortium

A randomized controlled trial of oral chloral hydrate vs intranasal dexmedetomidine plus buccal midazolam for auditory brainstem response testing in children

Paediatric procedural sedation at a tertiary care university teaching hospital in India

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