The effect of nebulized dexmedetomidine as sedative premedication in pediatrics undergoing cochlear implantation

Ali, Rania M; Mahmoud, Noura M. Youssri

doi:10.1080/11101849.2022.2079901

Cited by 4 publications

(7 citation statements)

References 34 publications

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“…This may well apply to the nebulized route, which augments the surface area coverage with a thin layer of the drug (12). We attempted to investigate Neb-Dex and compare its efficacy with IV-Dex for attenuating LI since literature regarding Neb-Dex is primarily restricted to procedural sedation as premedication or helping allay separation anxiety in pediatric age group (13)(14)(15)(16)(17)(18). Nebulization provides advantages including cheaper and easier administration, utilization even in resource-limited settings (not requiring special devices like syringe pumps/intranasal atomization devices, etc.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Intravenous Versus Nebulized Dexmedetomidine for Laryngoscopy and Intubation-Induced Sympathoadrenal Stress Response Attenuation

Singh¹,

Pahade²,

Mowar³

2022

Anesth Pain Med

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Background: Nebulized dexmedetomidine has been used for procedural sedation and allaying separation anxiety in children. Literature regarding its use in the attenuation of laryngoscopy and intubation response via the nebulized route is scarce. We evaluated preoperative dexmedetomidine nebulization on the hemodynamic response arising from laryngoscopy/intubation, hemodynamics, analgesic consumption, and postoperative sore throat. Objectives: The primary objective was to evaluate/compare the hemodynamic effects of preoperative intravenous and nebulized dexmedetomidine on laryngoscopy/intubation and compare the efficacy of the two routes in blunting the sympathoadrenal response. The secondary objective was to evaluate their effects on intraoperative analgesic consumption and incidence and sore throat postoperatively. Methods: 120 ASA I & II adult patients undergoing elective surgeries requiring tracheal intubation were randomized to receive intravenous dexmedetomidine (1 µg/kg over 10 minutes) and nebulized dexmedetomidine (1 µg/kg in 3 - 4 mL of 0.9% saline), 30 min before anesthesia induction. Heart rate and non-invasive blood pressure were monitored for 10 min following laryngoscopy and then throughout the surgery. Intraoperative analgesic consumption, postoperative sore throat, and recovery from anesthesia were assessed. Results: No significant hemodynamic difference was found between the two groups till three minutes. Then, the difference turned significant owing to a greater fall in the heart rate and mean arterial pressure in the intravenous group. Nebulized dexmedetomidine exhibited a lesser tendency of hypo/hypertension and brady/tachycardia, while hemodynamics was more stable. There was lesser sore throat and sedation in the nebulized group. Intraoperative analgesic and propofol consumption was comparable between the two groups. Conclusions: Nebulized dexmedetomidine attenuated laryngoscopy and intubation response, although to a lesser extent than the intravenous group in equivalent doses. However, the nebulized route provided greater hemodynamic stability in the intraoperative period and lesser sedation/sore throat postoperatively without an increase in adverse effects. Nebulized dexmedetomidine may provide a more holistic and viable alternative in patients who poorly tolerate hypotension, bradycardia, and sedation.

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Section: Discussionmentioning

confidence: 99%

Comparison of Intravenous Versus Nebulized Dexmedetomidine for Laryngoscopy and Intubation-Induced Sympathoadrenal Stress Response Attenuation

Singh¹,

Pahade²,

Mowar³

2022

Anesth Pain Med

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“…Among these, full text could not be found for one article, and after reading the remaining 71 articles, 51 articles that did not meet the inclusion criteria were excluded. Finally, 20 RCTs were included in this network metaanalysis [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34]. The flowchart is shown in Fig.…”

Section: Systemic Retrieval Resultsmentioning

confidence: 99%

“…A total of 2521 children younger than 18 years old from 20 RCTs were included in this network meta-analysis, with a sex ratio (Man/Female) of 1607: 914. Among the included studies, 10 articles were from China [20, 24-26, 28, 30-34], 4 from India [19,22,23,29], 3 from Egypt [17,18,21], 1 from United States of America [27], 1 from Australia [15] and 1 from Saudi Arabia [16]. Table 1 presents the baseline characteristics of each trial, and Fig.…”

Section: Basic Information Of Included Studiesmentioning

confidence: 99%

Effects of different doses of intranasal dexmedetomidine on related complications and parents’ satisfaction in anesthetized children: a systematic review

Hu,

Wang,

Sun

2024

BMC Pediatr

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Background Agitation/delirium is commonly seen in children after anesthesia, and a proper dose of dexmedetomidine can prevent this complication. This study aimed to investigate the effects of different doses of Dexmedetomidine (DEX) on agitation/delirium and other complications in anesthetized children, providing clinical evidence for dose recommendations of DEX. Methods This study was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A systematic search was conducted in the Cochrane Library, PubMed, Web of Science, and EMBASE. Two independent researchers performed literature screening, data extraction, and assessed the methodological quality. Data analysis was conducted using R and STATA 16.0. Results In the final analysis, 20 randomized controlled trials (RCTs) involving 2521 children were included. The results showed that in comparison to normal saline, 1 µg/kg, 1.5 µg/kg, and 2 µg/kg intranasal DEX significantly reduced the incidence of post-anesthetic emergence agitation in children with the most effective dose being 2 µg/kg (SUCRA = 0.91). Compared with normal saline, 1 µg/kg, 1.5 µg/kg, and 2 µg/kg intranasal DEX reduced patient’s need for postoperative analgesia, with the most effective dose being 1.5 µg/kg (SUCRA = 0.78). However, 1 µg/kg DEX performed the best in reducing Pediatric Anaesthesia Emergence Delirium (PAED) Scale score (SUCRA = 0.88). Conclusion Compared with normal saline, intranasal administration of 2 µg/kg DEX and 1.5 µg/kg DEX are the optimal doses to reduce the incidence of agitation and the need for postoperative pain relief in children under general anesthesia. Given effectiveness and safety, intranasal use of 1 µg/kg DEX appears to be the most effective dosage for anesthetized children.

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“…Another recent systematic review of 10 RCTs including 1233 patients established sedative efficacy of nebulized dexmedetomidine in pediatric patients undergoing medical examination or surgery [ 3 ]. Nebulized dexmedetomidine has been shown to ease and improve acceptability of IV cannulation; difficult in pediatric population owing to small veins and physical agitation [ 8 , 31 – 33 ]. Postoperative sore throat is a common adverse effect after laryngoscopy and ETI and is associated with patient discomfort and dis-satisfaction after GA [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

Nebulized dexmedetomidine for attenuating hemodynamic response to laryngoscopy and endotracheal intubation in adult patients undergoing surgeries under general anaesthesia: a systematic review and meta-analysis of randomized controlled trials

Gupta,

Rohilla,

Gupta

et al. 2023

BMC Anesthesiol

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Background Sympathetic stimulation associated with laryngoscopy and endotracheal intubation (ETI) may lead to adverse cardio-/cerebro-vascular events in susceptible patients. Nebulization is a novel route for dexmedetomidine administration providing a large surface area for absorption while avoiding bradycardia and hypotension associated with intravenous route. We aimed to evaluate the efficacy and safety of dexmedetomidine nebulization for attenuating hemodynamic response to ETI in adult patients undergoing surgery under general anaesthesia. Methods This systematic review was registered prospectively in the International Prospective Register of Systematic Reviews (CRD42023403624). PubMed, Embase (OvidSP), Cochrane library, Scopus (Elsevier), Web of Science (Clarivate) and Google Scholar were systematically searched from database inception until March 31, 2023. Two reviewers independently screened titles, abstracts and then full text against pre-specified eligibility criteria. Randomized controlled trials (RCTs) assessing effect of dexmedetomidine nebulization on hemodynamic response to ETI in adult patients undergoing surgeries under general anaesthesia were included. All studies reporting heart rate and systolic blood pressure at baseline and various time points after ETI were included. A pre-piloted data extraction form, Cochrane revised risk-of-bias tool (ROB 2) tool, GRADE approach and RevMan 5.4.1 (Cochrane Collaboration, Copenhagen, Denmark) were used for data extraction, risk of bias assessment, rating certainty of evidence and data synthesis respectively. Mean difference and relative risk with 95% Confidence Interval (CI) were used for continuous and dichotomous variables respectively. Results Six RCTs randomized 480 patients with ASA I/II patients aged < 60 years of age and undergoing elective surgeries to receive either dexmedetomidine (n = 240) or saline nebulization (n = 240). Except for one RCT which used 2 μg/kg, all other RCTs used dexmedetomidine dose of 1 μg /kg. Heart rate, systolic, diastolic and mean blood pressure were significantly lower in the dexmedetomidine group at all the measured time points after laryngoscopy and ETI with the only exception being systolic blood pressure at 3 min [mean difference -13.86 (95% CI -30.01 to 2.99), p = 0.09]. Bradycardia and hypotension as adverse effects were absent across the included studies. However, only one-third of the included studies had a low risk of bias and strength of evidence was very low according to the GRADE assessment. Conclusions Compared to placebo, premedication with dexmedetomidine nebulization was associated with lower HR and BP following ETI without any risk of bradycardia and hypotension. However, the strength of evidence was very poor and came from just one country. Future well designed and conducted studies in different populations are warranted. Trial registration PROSPERO Registration number: CRD42023403624

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The effect of nebulized dexmedetomidine as sedative premedication in pediatrics undergoing cochlear implantation

Cited by 4 publications

References 34 publications

Comparison of Intravenous Versus Nebulized Dexmedetomidine for Laryngoscopy and Intubation-Induced Sympathoadrenal Stress Response Attenuation

Comparison of Intravenous Versus Nebulized Dexmedetomidine for Laryngoscopy and Intubation-Induced Sympathoadrenal Stress Response Attenuation

Effects of different doses of intranasal dexmedetomidine on related complications and parents’ satisfaction in anesthetized children: a systematic review

Nebulized dexmedetomidine for attenuating hemodynamic response to laryngoscopy and endotracheal intubation in adult patients undergoing surgeries under general anaesthesia: a systematic review and meta-analysis of randomized controlled trials

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