Use of Intranasal Dexmedetomidine as a Solo Sedative for MRI of Infants

Olgun, Gokhan; Ali, Mir Hyder

doi:10.1542/hpeds.2017-0120

Cited by 31 publications

(35 citation statements)

References 23 publications

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“…Intranasal dexmedetomidine offers an alternative approach for pediatric sedation . In previous studies, the overall success rate of intranasal dexmedetomidine for pediatric procedural sedation ranged from 87% to 96.2%, which is consistent with our findings . However, the potential hemodynamic effects of intranasal dexmedetomidine sedation (hypotension and bradycardia) are a key concern.…”

Section: Discussionsupporting

confidence: 91%

“…17 In previous studies, the overall success rate of intranasal dexmedetomidine for pediatric procedural sedation ranged from 87% to 96.2%, which is consistent with our findings. 18,19 However, the potential hemodynamic effects of intranasal dexmedetomidine sedation (hypotension and bradycardia) are a key concern. There is no clear consensus on the definition of bradycardia in the pediatric population.…”

Section: Discussionmentioning

confidence: 99%

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Incidence and risk factors of bradycardia in pediatric patients undergoing intranasal dexmedetomidine sedation

Huang

Tang

et al. 2019

Acta Anaesthesiol Scand

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Background: Dexmedetomidine is widely used for non-invasive pediatric procedural sedation. However, the hemodynamic effects of intravenous dexmedetomidine are a concern. There has been a growing interest in the application of intranasal dexmedetomidine as a sedative in children. Objective: To investigate the incidence of bradycardia in children undergoing intranasal dexmedetomidine sedation and to identify the associated risk factors. Methods: Data pertaining to pediatric patients who underwent intranasal dexmedetomidine sedation for non-invasive investigations at the Kunming Children's Hospital between October 2017 and August 2018 were retrospectively analyzed. Results: Out of 9984 children who qualified for inclusion, 228 children (2.3%) developed bradycardia. The incidence of bradycardia in the group that received additional dose of dexmedetomidine was higher than that in the group that did not receive additional dose (9.2% vs 16.7%; P = .003). The incidence of bradycardia in males was higher than that in females (2.6% vs 1.8%; P = .007). On multivariate logistic regression, only male gender showed an independent association with the occurrence of bradycardia (odds ratio 1.48; 95% confidence interval 1.11-1.97; P = .008). Conclusions: The overall incidence of bradycardia in children after sole use of intranasal dexmedetomidine sedation was 2.3%. Male children showed a 1.48-fold higher risk of bradycardia. However, the blood pressure of the children who developed bradycardia was within the normal range. Simple wake-up can effectively manage bradycardia induced by intranasal dexmedetomidine sedation. How to cite this article: Lei H, Chao L, Miao T, et al. Incidence and risk factors of bradycardia in pediatric patients undergoing intranasal dexmedetomidine sedation.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Incidence and risk factors of bradycardia in pediatric patients undergoing intranasal dexmedetomidine sedation

Huang

Tang

et al. 2019

Acta Anaesthesiol Scand

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“…In addition, a starting dose of 3 μg/kg was used in many of our patients who had failed to complete MRI scans with IN dexmedetomidine as a sole agent. This was lower than what was used in prior studies, which had shown that a higher dose of 4 μg/kg was associated with better outcomes and lower rate of anaesthetic rescue (4,26). This suggests that long and rest-disruptive procedures-in particular MRI scans-should be performed with a higher dose of sedation.…”

Section: Discussionmentioning

confidence: 69%

Factors affecting successful use of intranasal dexmedetomidine: a cohort study from a national paediatrics tertiary centre

Fan

Lim²,

Wong

et al. 2021

Transl Pediatr

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Background: Use of intranasal (IN) dexmedetomidine for procedural sedation has been reported in recent years. Good patient selection is important to ensure high success rates. We aimed to identify factors that influence the successful use of IN dexmedetomidine in non-invasive investigations. Methods: All paediatric patients who received IN dexmedetomidine for investigations between 01 July 2019 to 01 July 2020 were included. Baseline demographics, time to reach adequate sedation level, duration of sedation, dose, indications for sedation and need for rescue sedatives were recorded. Procedures were classified into "long" or "short" according to completion time. Successful sedation was defined by completion of investigations by IN dexmedetomidine alone. Results: Of 105 patients included, median age was 20.0 months, and median weight 11.0 kg. Magnetic resonance imaging (56, 53.3%) was the most common indication. Sixty (57.1%) were successfully sedated using IN dexmedetomidine alone. Automated auditory brainstem response, computerised tomography and mercaptoacetyltriglycine-3 renogram scans had the highest success rate (83.3%, 83.3%, and 100% respectively). On multivariate analysis, short procedures had an adjusted odds ratio of 5.30 (95% CI: 1.69-16.61; P=0.004) compared to long procedures.Conclusions: IN dexmedetomidine is effective for procedural sedation for paediatric patients. The most important predictor for sedation success was indication of sedation and duration of procedures.

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“…One study of the application of dexmedetomidine Intranasal by Olgun et al stated a dose of 4 µg/kg was proven effective in providing a sedative effect in infants aged 1 to 12 months. 5 This study determined the dose based on several previous studies. In a study by Sulton et al, the use of dexmedetomidine IN 3 mg/kg was proven to be effective in children's MRI procedures, without side effects.…”

Section: Dexmedetomidine Dosagementioning

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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Use of Intranasal Dexmedetomidine as a Solo Sedative for MRI of Infants

Abstract: IN dexmedetomidine is an effective solo sedative agent for MRI in infants.

Cited by 31 publications

References 23 publications

Incidence and risk factors of bradycardia in pediatric patients undergoing intranasal dexmedetomidine sedation

Incidence and risk factors of bradycardia in pediatric patients undergoing intranasal dexmedetomidine sedation

Factors affecting successful use of intranasal dexmedetomidine: a cohort study from a national paediatrics tertiary centre

The Use of Dexmedetomidine on Pediatrics Undergoing MRI Examinations

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