Premedication with intranasal dexmedetomidine decreases barbiturate requirement in pediatric patients sedated for magnetic resonance imaging: a retrospective study

Abstract

Background Barbiturates are commonly used in ambulatory sedation of pediatric patients. However, use of barbiturates involve risks of respiratory complications. Dexmedetomidine, a highly selective α 2 -adrenoceptor agonist, is increasingly used for pediatric sedation. Premedication with intranasal (IN) dexmedetomidine offers a non-invasive and efficient possibility to sedate pediatric patients undergoing magnetic resonance imaging (MRI). Our hypothesis was that dexmedetomidine would reduce barbiturate requirements in procedural sedation. Methods We included 200 consecutive pediatric patients undergoing MRI, and analyzed their hospital records retrospectively. Half of the patients received 3 μg/kg of IN dexmedetomidine (DEX group) 45–60 min before MRI while the rest received only thiopental (THIO group) for procedural sedation. Sedation was maintained with further intravenous thiopental dosing as needed. Thiopental consumption, heart rate (HR) and peripheral oxygen saturation were recorded. Results The cumulative thiopental requirement during MRI was (median and interquartile range [IQR]) 4.4 (2.7–6.0) mg/kg/h in the DEX group and 12.4 (9.8–14.8) mg/kg/h in the THIO group (difference 7.9 mg/kg/h, 95% CI 6.8–8.8, P < 0.001). Lowest measured peripheral oxygen saturation remained slightly higher in the DEX group compared to the THIO group (median nadirs and IQR: 97 (95–97) % and 96 (94–97) %, P < 0.001). Supplemental oxygen was delivered to 33% of the patients in the THIO group compared to 2% in the DEX group ( P < 0.001). The lowest measured HR (mean and SD) was lower (78 (16) bpm) in the DEX group compared to the THIO group (92 (12) bpm) ( P < 0.001). Conclusion Premedication with IN dexmedetomidine (3 μg/kg) was associated with markedly reduced thiopental dosage needed for efficient procedural sedation for pediatric MRI. Electronic supplementary material The online version of this article (10.1186/s12871-019-0690-1) contains supplementary material, which is available to authorized users.

Emergence delirium and intranasal dexmedetomidine premedication in pediatric anesthesia: a retrospective study in plastic surgery

“…With respect to safety, our results are in line with previous reports [12,29,32], since no patients who received dexmedetomidine intranasally in premedication had significant hemodynamic effects.…”

Emergence delirium and intranasal dexmedetomidine premedication in pediatric anesthesia: a retrospective study in plastic surgery

“…This finding is of major relevance, since the use of dexmedetomidine has been poorly explored to date in pediatric patients subjected to combined anesthesia. Moreover, this observation indirectly shows a relationship between regional anesthesia and reduced ED occurrence, which might be attributed to the decreased need for volatile anesthetic, a known risk factor for ED [28].With respect to safety, our results are in line with previous reports [12,30,34], since no patients who received dexmedetomidine intranasally in premedication had significant hemodynamic effects. Moreover, at the same time, the administration given in advance compared with the intravenous one can avoid the delay in recovery from anesthesia and in length of staying in surgical area [17].…”

“…Dexmedetomidine is a high-affinity 2-mimetic drug. In particular, this molecule acts in the locus coeruleus determining a sedation pattern similar to natural sleep, without determining respiratory depression [12][13][14]. Recent studies suggest, among the remedies against ED, the use of dexmedetomidine intranasally as a premedication [10,11,15,16].…”

Two-center randomized controlled trial comparing oral chloral hydrate and intranasal combination of dexmedetomidine and ketamine for procedural sedation in children: study protocol

“…An advantage of dexmedetomidine is its high transmucosal bioavailability of 65-80% [ 37 , 38 ]. Intranasal dexmedetomidine can induce sedation within 30 min in pediatric patients [ 2 , 5 , 6 , 9 , 11 , 12 , 14 – 22 , 24 , 26 – 28 , 31 , 35 , 36 , 38 , 39 ] .A recent study reported that intranasal dexmedetomidine 4 μg/kg enabled magnetic resonance imaging (MRI) examination without apnea and hypoxemia in infants [ 27 ]; however, 30.7% (16/52) of the patients developed bradycardia (< 80% of the baseline heart rate) and 3.8% (2/52) developed hypotension (< 80% of the baseline mean arterial pressure). As such, intranasal dexmedetomidine alone can be associated with slow onset time, bradycardia, or hypotension.…”