Pediatric Sedation: The European Experience and Approach

Leroy, Piet L. J. M.; Stuart, Grant M.

doi:10.1007/978-3-030-58406-1_27

Cited by 2 publications

(2 citation statements)

References 112 publications

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“…The only other rectal option appears to be pentobarbital, which was the third most used sedative for head computerized tomography in children in 2017 in the US (cohort of n = 24,418 patients [ 10 ]. Apart from the US, pentobarbital in the rectal form is also used in France, but it has not been used in the UK since its withdrawal in the 1960s due to its potential for abuse [ 11 ] and therefore is not mentioned in the NICE Sedation in children and young people guideline, updated in 2019 [ 12 ]. However, as part of their systematic review of needle-free pharmacological sedation techniques in paediatric patients, de Rover et al reaffirmed the interest and need for better alternative sedation techniques to the I.V.…”

Section: Introductionmentioning

confidence: 99%

Development and Stability of a New Formulation of Pentobarbital Suppositories for Paediatric Procedural Sedation

et al. 2023

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Pentobarbital is a drug of choice to limit motion in children during paediatric procedural sedations (PPSs). However, despite the rectal route being preferred for infants and children, no pentobarbital suppositories are marketed, and therefore they must be prepared by compounding pharmacies. In this study, two suppository formulations of 30, 40, 50, and 60 mg of pentobarbital sodium were developed using hard-fat Witepsol® W25 either alone (formulation F1) or with oleic acid (formulation F2). The two formulations were subjected to the following tests described in the European Pharmacopoeia: uniformity of dosage units, softening time, resistance to rupture, and disintegration time. The stability of both formulations was also investigated for 41 weeks of storage at 5 ± 3 °C using a stability-indicating liquid chromatography method to quantify pentobarbital sodium and research breakdown product (BP). Although both formulae were compliant to uniformity of dosage, the results were in favour of a faster disintegration of F2 compared to F1 (−63%). On the other hand, F1 was found to be stable after 41 weeks of storage unlike F2 for which several new peaks were detected during the chromatographic analysis, suggesting a shorter stability of only 28 weeks. Both formulae still need to be clinically investigated to confirm their safety and efficiency for PPS.

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Section: Introductionmentioning

confidence: 99%

Development and Stability of a New Formulation of Pentobarbital Suppositories for Paediatric Procedural Sedation

et al. 2023

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“…Strategies based on playful preparation and distraction have been shown to enhance success [1]. However, some children will need deep sedation or even anesthesia to enable MRI [2] In many European countries, and particularly in non-university hospitals, there is limited availability of pediatric anesthesia services for procedures outside the operation room, such as MRI [3]. Facing this challenge, pediatric practitioners often have no other option than to rely on inferior sedation strategies such as midazolam or chloralhydrate, which are associated with lower success rates and more adverse events [4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

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

schuiten

Valerio

Leroy

2023

Preprint

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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.

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Pediatric Sedation: The European Experience and Approach

Cited by 2 publications

References 112 publications

Development and Stability of a New Formulation of Pentobarbital Suppositories for Paediatric Procedural Sedation

Development and Stability of a New Formulation of Pentobarbital Suppositories for Paediatric Procedural Sedation

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

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