The 95% effective dose of intranasal dexmedetomidine sedation for pulmonary function testing in children aged 1–3 years: A biased coin design up-and-down sequential method

Li, Shangyingying; Liu, Hui; Zhang, Jing; Liu, Yang; Yu, Qian; Sun, Mei; Tian, Qing; Yang, Fei; Yao, Lei; Liu, Xiaoling; Tu, Shengfen

doi:10.1016/j.jclinane.2020.109746

Cited by 10 publications

(10 citation statements)

References 27 publications

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“…However, following a positive response (success of LOC), the next patient is randomized with a probability of 0.05 to the next lower dose and with a probability of 0.95 to the same dose. Examples of the biased coin up-and-down method in anesthesia studies finding an ED 95 dose can be found in numerous studies [25][26][27][28][29].…”

Section: Discussionmentioning

confidence: 99%

Determination of the 95% effective dose of remimazolam to achieve loss of consciousness during anesthesia induction in different age groups

Park

Lee

et al. 2022

Korean J Anesthesiol

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Background: Remimazolam is a new ultrashort-acting benzodiazepine originally developed as an improved version of midazolam. Recent studies demonstrated non-inferiority of remimazolam to propofol in general anesthesia. However, to date, few studies have investigated the induction bolus dose of remimazolam required to achieve general anesthesia. We aimed to determine the 95% effective dose (ED 95 ) of remimazolam bolus that is required to achieve loss of consciousness (LOC) and the appropriate doses for different age groups.Methods: Patients aged 20-79 years with American Society of Anesthesiologists physical status of I or II were enrolled in this study. A total of 120 patients were included representing young, middle-aged, and elderly groups. Loss of eyelash reflex and verbal response after the administration of remimazolam was considered successful LOC. The ED 95 of remimazolam was determined using a biased coin up-and-down design with sequential allocation and the isotonic regression method. Results:The ED 95 of remimazolam for induction of general anesthesia was 0.37 mg/kg (95% confidence interval [CI]: 0.28-0.39) in the young group, 0.37 mg/kg (95% CI: 0.27-0.39) in the middle-aged group, and 0.25 mg/kg (95% CI: 0.2-0.29) in the elderly group. During the study period, none of the patients required rescue medications for hypotension or bradycardia. Conclusions:This study investigated the ED 95 of remimazolam bolus for anesthesia induction, and precise dosing of ED 95 can help maintain hemodynamic stability during induction.

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Section: Discussionmentioning

confidence: 99%

Determination of the 95% effective dose of remimazolam to achieve loss of consciousness during anesthesia induction in different age groups

Park

Lee

et al. 2022

Korean J Anesthesiol

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“…Administration of chloral hydrate, propofol, and midazolam can affect children's expiratory flows when providing sedation for PFT. Recent literature supports the administration of intranasal DEX (2.64 mcg/kg) sedation for PFTs in children aged 1-3 years [31].…”

Section: Respiration and Airway Collapsibilitymentioning

confidence: 92%

“…Recent trials showed that 2-4 mcg/kg of IN DEX in the pediatric population produced successful sedation in 70% to 100%. The characteristics of these trials are summarized in Table 1 [31,[86][87][88][89][90]. When compared to traditional agents used for pediatric sedation (i.e., midazolam, propofol, chloral hydrate), =IN DEX (1 to 3 mcg/kg) was effective in providing adequate procedural sedation without significant adverse events.…”

Section: Updates On Alternative Routes Of Administrationmentioning

confidence: 99%

Dexmedetomidine: What’s New for Pediatrics? A Narrative Review

Mahmoud

Barbi

Mason

2020

JCM

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Over the past few years, despite the lack of approved pediatric labelling, dexmedetomidine’s (DEX) use has become more prevalent in pediatric clinical practice as well as in research trials. Its respiratory-sparing effects and bioavailability by various routes are only some of the valued features of DEX. In recent years the potential organ-protective effects of DEX, with the possibility for preserving neurocognitive function, has put it in the forefront of clinical and bench research. This comprehensive review focused on the pediatric literature but presents relevant, supporting adult and animal studies in order to detail the recent growing body of literature around the pharmacology, end-organ effects, organ-protective effects, alternative routes of administration, synergetic effects, and clinical applications, with considerations for the future.

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“…At present, there is no relevant study on 95% effective dose of intranasal DEX in adults. According to Li et al's study ( 23 ), 95% effective dose of intranasal DEX in children was 2.64 μg/kg. Referring to this dose, we carried out a pre-experiment via setting up three experimental groups (2.0, 2.5, and 3.0 μg/kg).…”

Section: Methodsmentioning

confidence: 99%

“…Studies suggested that DEX-induced deep sedation mimics stages 2 and 3 of non-rapid eye movement (NREM) sleep ( 21 , 22 ). In particular, it does not cause respiratory depression ( 23 ).…”

Section: Introductionmentioning

confidence: 99%

Intranasal Dexmedetomidine for the Treatment of Pre-operative Anxiety and Insomnia: A Prospective, Randomized, Controlled, and Clinical Trial

et al. 2022

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Background and ObjectiveSeveral patients with pre-operative anxiety and insomnia refuse to take sleeping pills because of the side effects of sleeping pills. This study aimed to evaluate the applicability of intranasal dexmedetomidine (DEX) in the treatment of pre-operative anxiety and insomnia.MethodsA total of 72 patients with insomnia and anxiety were randomly divided into two groups of intranasal DEX (n = 36) and intranasal normal saline (NS, n = 36). The primary outcomes included patients' time to fall asleep, total sleep time, insomnia severity index (ISI) after treatment, and satisfaction with the treatment effect. The secondary outcomes were mean arterial pressure (MAP), oxygen saturation (SPO2), heart rate (HR), Narcotrend index (NI) in the first 2 h of treatment, and the incidence of adverse events within 12 h after treatment.ResultsThe time to fall asleep (22.08 ± 3.95 min) and total sleep time (400.06 ± 28.84 min) in the DEX group were significantly different from those in the NS group [time to fall asleep, 89.31 ± 54.56 min; total sleep time (295.19 ± 73.51 min; P < 0.001)]. ISI after treatment in the DEX group was lower than that in the NS group (P < 0.001). Satisfaction with the treatment effect was better in the DEX group than that in the NS group (P < 0.001). The general vital signs in the two groups were stable during the treatment. The drowsiness rate in the NS group was higher than that in the DEX group (P < 0.001).ConclusionIntranasal DEX can significantly improve pre-operative anxiety and insomnia.Clinical Trial RegistrationThis study was registered on Chinese Clinical Trial Registry (http://www.chictr.org.cn/searchproj.aspx, ChiCTR2100044747).

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The 95% effective dose of intranasal dexmedetomidine sedation for pulmonary function testing in children aged 1–3 years: A biased coin design up-and-down sequential method

Cited by 10 publications

References 27 publications

Determination of the 95% effective dose of remimazolam to achieve loss of consciousness during anesthesia induction in different age groups

Determination of the 95% effective dose of remimazolam to achieve loss of consciousness during anesthesia induction in different age groups

Dexmedetomidine: What’s New for Pediatrics? A Narrative Review

Intranasal Dexmedetomidine for the Treatment of Pre-operative Anxiety and Insomnia: A Prospective, Randomized, Controlled, and Clinical Trial

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