The Sedative Effects of Inhaled Nebulized Dexmedetomidine on Children: A Systematic Review and Meta-Analysis

Abstract

BackgroundChildren that need surgery and medical examinations are often uncooperative, and preoperative sedation is necessary. We aimed to assess the safety and efficacy of inhaled nebulized dexmedetomidine in children for sedation that underwent medical examinations or surgery.MethodsWe systematically searched PubMed, Web of science, Embase, and Cochrane library, for randomized controlled trials of Intranasal dexmedetomidine using a spray or a mucosal atomization device in children undergoing examination or elective surgery. We included all studies that analyzed the sedation efficiency of intranasal dexmedetomidine in children.ResultsTen studies with 1,233pediatric patients were included. Compared to other sedation treatments, inhaled nebulized dexmedetomidine showed similar sedation satisfaction [risk ratio RR: 1.02; 95% confidence interval (CI): 0.87–1.18; P = 0.83; I2 = 72%]. there was also no statistical difference in the success rate of separation from parents (RR: 0.96; 95% CI: 0.82–1.12; P = 0.58; I2 = 67%), and mask acceptability (RR: 1; 95% CI: 0.83–1.20; P = 0.99; I2 = 35%). But it is worth mentioning that nebulized dexmedetomidine combined with ketamine provided better sedation satisfaction (RR: 0.69; 95% CI: 0.49–0.96; I2 = 49%) and more satisfactory separation from parents (RR: 0.85; 95% CI: 0.74–0.97; I2 = 0%). Moreover, nebulized dexmedetomidine reduced the occurrences of nausea and vomiting (RR: 0.28; 95% CI: 0.15–0.51; P < 0.01; I2 = 10%) and emergence agitation (RR: 0.30; 95% CI: 0.18–0.49; P < 0.01; I2 = 0%). There are no hypotension or arrhythmia reported that required intervention in all articles.ConclusionCompared to other premedication treatments, inhaled nebulized dexmedetomidine provided equivalent sedation satisfaction for the examination or preoperative sedation of children, but it reduced the occurrences of emergence agitation and postoperative nausea and vomiting.

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

“…However, low number of studies precluded meta-analysis of these outcome. Some of these advantages might be attributed to sedative and analgesic action of dexmedetomidine by virtue of its α2-agonistic action on the locus coeruleus [ 3 ]. Its dose-sparing effect on opioid and anaesthetic requirements have been shown to be comparable with intravenous dexmedetomidine [ 14 ].…”

“…Its short half-life and elimination life and easy acceptability in addition to its ability to provide a calm and sedated patient at induction, lower anaesthetic and analgesic requirements and devoid of adverse effects make nebulized dexmedetomidine an ideal premedication agent [ 13 , 29 ]. The sedative action of nebulized dexmedetomidine is particularly advantageous in pediatric patients in whom it has been shown to reduce separation anxiety, recovery time, postoperative agitation, postoperative nausea and vomiting and improve mask acceptance; with nebulized dexmedetomidine shown to be better compared with nebulized ketamine and midazolam [ 3 , 29 , 30 ]. 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 ].…”

“…The sedative action of nebulized dexmedetomidine is particularly advantageous in pediatric patients in whom it has been shown to reduce separation anxiety, recovery time, postoperative agitation, postoperative nausea and vomiting and improve mask acceptance; with nebulized dexmedetomidine shown to be better compared with nebulized ketamine and midazolam [ 3 , 29 , 30 ]. 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 ].…”

“…Dexmedetomidine is a centrally acting α-2 adrenergic agonist with sedative, hypnotic, analgesic, anxiolytic, antisialagogue, antinociceptive and sympatholytic action [2,3]. Premedication with dexmedetomidine through intravenous, intramuscular and intranasal route has been shown to effectively attenuate hemodynamic response to laryngoscopy and ETI [4][5][6][7][8][9][10].…”

Search for the ideal route of premedication in children.. far from over?

“…In preschool children, nebulised dexmedetomidine has shown more satisfactory sedation, less parental separation anxiety and emergence agitation than those who received nebulised ketamine or midazolam. [ 34 ] This route to awaits approval from regulatory bodies. Mask anxiety and mask fit are also practical issues in this age group.…”