Safety and Efficacy of Buccal Dexmedetomidine for MRI Sedation in School-Aged Children

Boriosi, Juan P.; Eickhoff, Jens; Hollman, Gregory A.

doi:10.1542/hpeds.2018-0162

Cited by 21 publications

(22 citation statements)

References 19 publications

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“…With more requests for procedural sedation for diagnostics procedures like MRI, ambulatory center procedures, dexmedetomidine has become an attractive option for non-IV route of sedation especially buccal administration at least 45 min before the elected time in a dose 2 to 3 μg/kg. This provides adequate sedation in approximately 80% of patients with a failure rate of 20% requiring other modes of sedation [25].…”

Section: Pediatric Considerationsmentioning

confidence: 99%

Dexmedetomidine in Enhanced Recovery After Surgery (ERAS) Protocols for Postoperative Pain

Kaye

Chernobylsky

Thakur

et al. 2020

Curr Pain Headache Rep

141

111

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Purpose of Review Effective acute pain management has evolved considerably in recent years and is a primary area of focus in attempts to defend against the opioid epidemic. Persistent postsurgical pain (PPP) has an incidence of up to 30-50% and has negative outcome of quality of life and negative burden on individuals, family, and society. The 2016 American Society of Anesthesiologists (ASA) guidelines states that enhanced recovery after surgery (ERAS) forms an integral part of Perioperative Surgical Home (PSH) and is now recommended to use a multimodal opioid-sparing approach for management of postoperative pain. As such, dexmedetomidine is now being used as part of ERAS protocols along with regional nerve blocks and other medications, to create a satisfactory postoperative outcome with reduced opioid consumption in the Post anesthesia care unit (PACU). Recent Findings Dexmedetomidine, a selective alpha 2 agonist, possesses analgesic effects and has a different mechanism of action when compared with opioids. When dexmedetomidine is initiated at the end of a procedure, it has a better hemodynamic stability and pain response than ropivacaine. Dexmedetomidine can be used as an adjuvant in epidurals with local anesthetic sparing effects. Its use during nerve blocks results in reduced postoperative pain. Also, local infiltration of IV dexmedetomidine is associated with earlier discharge from PACU. Summary Perioperative use of dexmedetomidine has significantly improved postoperative outcomes when used as part of ERAS protocols. An in-depth review of the use of dexmedetomidine in ERAS protocols is presented for clinical anesthesiologists.

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Section: Pediatric Considerationsmentioning

confidence: 99%

Dexmedetomidine in Enhanced Recovery After Surgery (ERAS) Protocols for Postoperative Pain

Kaye

Chernobylsky

Thakur

et al. 2020

Curr Pain Headache Rep

141

111

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“…The success rate of sedation for pediatric MRI ranges from 83.3% with a 1 μg/kg bolus followed by 0.5 μg/kg/hr infusion to 98% with a 3 μg/kg bolus followed by 2 μg/kg/hr infusion [47,53]. Buccal (a mean of 2.20 ± 0.38 μg/kg) and intranasal (3 μg/kg) administration of dexmedetomidine may be useful in children with difficult IV cannulation, but their success rates of sedation for MRI are lower than IV administration and more sedative supplementation is required than IV administration [34,35,55,56]. Generally, a lack of respiratory depression combined with a relatively short half-life makes dexmedetomidine a useful single sedative agent for an ambulatory pediatric MRI setting.…”

Section: ) Dexmedetomidinementioning

confidence: 99%

“…Although NICE recommends the consideration of midazolam as one of the first-line sedative drug for painless imaging procedures owing to a wide margin of safety [ 13 ], it is currently used as an adjuct sedative with either dexmedetomidine or ketamine rather than single primary agent for pediatric MRI [ 18 , 34 - 37 ] because of the high sedation failure rates, short duration of action, as well as frequent significant respiratory depression at deeply sedating doses [ 38 , 39 ]. However, coadministration of midazolam and other sedative agents, especially opioids, in children is not acceptable because of siginficant increases in cardiorespiratory depression and difficulty in predicting sedation effects [ 9 ].…”

Section: Drugs For Deep Sedation or General Anesthesia For Pediatric mentioning

confidence: 99%

Drug selection for sedation and general anesthesia in children undergoing ambulatory magnetic resonance imaging

Jung

2020

Yeungnam Univ J Med

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The prevalence of magnetic resonance imaging (MRI) for diagnosing and monitoring a wide range of disease in children continues to expand with the efficacy benefit of providing high-resolution images of tissue anatomy and quantitative function and the safety advantage of a lack of ionizing radiation [1,2]. Aspects of MRI scans such as loud noises, confined bore of the magnet, and the required immobility to prevent motion artifacts are the causes of anxiety and barriers to successful performance of the procedure in children younger than 6 years and those at any age with development delay, claustrophobia, or involuntary movements or con-The demand for drug-induced sedation for magnetic resonance imaging (MRI) scans have substantially increased in response to increases in MRI utilization and growing interest in anxiety in children. Understanding the pharmacologic options for deep sedation and general anesthesia in an MRI environment is essential to achieve immobility for the successful completion of the procedure and ensure rapid and safe discharge of children undergoing ambulatory MRI. For painless diagnostic MRI, a single sedative/anesthetic agent without analgesia is safer than a combination of multiple sedatives. The traditional drugs, such as chloral hydrate, pentobarbital, midazolam, and ketamine, are still used due to the ease of administration despite low sedation success rate, prolonged recovery, and significant adverse events. Currently, dexmedetomidine, with respiratory drive preservation, and propofol, with high effectiveness and rapid recovery, are preferred for children undergoing ambulatory MRI. General anesthesia using propofol or sevoflurane can also provide predictable rapid time to readiness and scan times in infants or children with comorbidities. The selection of appropriate drugs as well as sufficient monitoring equipment are vital for effective and safe sedation and anesthesia for ambulatory pediatric MRI.

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“…The ideal sedation is described as a condition in which the patient becomes relaxed, sleepy, or falls asleep. 15 Furthermore, the ideal sedative agent should fulfill the criteria that are listed below:…”

Section: Use Of Dexmedetomidine In Infant Mrimentioning

confidence: 99%

The Use of Dexmedetomidine on Pediatrics Undergoing MRI Examinations

Suprobo

Yupono

Vitraludyono

2021

JAP

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Dexmedetomidine, an α2 adrenergic agonist, has been commonly used as an off-label anesthetic adjuvant in various procedures and age groups. Lately, dexmedetomidine is increasingly preferred as sedation for pediatric patients undergoing MRI, which requires the patient to remain still in a deep sedation without disturbing airway patency. Dexmedetomidine administration via intranasal or buccal route is preferred for pediatric patients. Dexmedetomidine does not undergo significant pharmacokinetic changes when used in conjunction with other anesthetics, and has a good safety profile. It is 8-10 times more selective against α2 receptors than clonidine and produces sedation, analgesia, vasodilation, and bradycardia without significant airway and respiratory depression risk. Unlike other anesthetic agents, dexmedetomidine does not have any negative effect on brain development. Compared with propofol, dexmedetomidine has a longer onset and duration of action. Thus, dexmedetomidine can be used as the sole sedating agent in infants and children undergoing MRI procedures, with good sedation results and minimal side effects. However, correct dosing is very important given the side effects of bradycardia and hypotension that can occur with its use.

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Safety and Efficacy of Buccal Dexmedetomidine for MRI Sedation in School-Aged Children

Cited by 21 publications

References 19 publications

Dexmedetomidine in Enhanced Recovery After Surgery (ERAS) Protocols for Postoperative Pain

Dexmedetomidine in Enhanced Recovery After Surgery (ERAS) Protocols for Postoperative Pain

Drug selection for sedation and general anesthesia in children undergoing ambulatory magnetic resonance imaging

The Use of Dexmedetomidine on Pediatrics Undergoing MRI Examinations

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