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Cozzi G, Zago A, Poropat F, Rabach I, Barbi E, Amaddeo A. Continuous Infusion of Dexmedetomidine for Maintenance of Sedation in an Aggressive Adolescent with Autism Spectrum Disorder in the Emergency Department. CHILDREN (BASEL, SWITZERLAND) 2024; 11:833. [PMID: 39062282 PMCID: PMC11276318 DOI: 10.3390/children11070833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Revised: 06/29/2024] [Accepted: 07/05/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND The treatment of aggressive behavior and agitation in pediatric patients with autism spectrum disorder (ASD) in the emergency department is topical and challenging. CASE PRESENTATION We described an adolescent with autism spectrum disorder treated ten times in the pediatric emergency department for severe episodes of aggressiveness and agitation. After resolving the acute phase of these behavioural crises, sedation was maintained with a continuous infusion of dexmedetomidine to prevent the resurgence of agitation and to organize discharge properly, considering the family's needs. The continuous infusion of dexmedetomidine allowed the patient to remain asleep most of the time during his stay at the emergency department. No adverse events were recorded. CONCLUSIONS The continuous infusion of dexmedetomidine could represent a safe and valuable tool to facilitate the permanence of the patient in the PED.
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Affiliation(s)
- Giorgio Cozzi
- Institute for Maternal and Child Health–IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (G.C.); (F.P.); (I.R.); (E.B.); (A.A.)
| | - Alessandro Zago
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34127 Trieste, Italy
| | - Federico Poropat
- Institute for Maternal and Child Health–IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (G.C.); (F.P.); (I.R.); (E.B.); (A.A.)
| | - Ingrid Rabach
- Institute for Maternal and Child Health–IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (G.C.); (F.P.); (I.R.); (E.B.); (A.A.)
| | - Egidio Barbi
- Institute for Maternal and Child Health–IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (G.C.); (F.P.); (I.R.); (E.B.); (A.A.)
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34127 Trieste, Italy
| | - Alessandro Amaddeo
- Institute for Maternal and Child Health–IRCCS “Burlo Garofolo”, 34137 Trieste, Italy; (G.C.); (F.P.); (I.R.); (E.B.); (A.A.)
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Li SJ, Shen KF, He L, Zhang YP, Ming L, Wu ZF. Clinical Analysis of Intranasal Dexmedetomidine Combined With Midazolam in Pediatric Cranial Magnetic Resonance Examinations. J Perianesth Nurs 2023; 38:925-929. [PMID: 37278686 DOI: 10.1016/j.jopan.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 06/07/2023]
Abstract
PURPOSE To observe the efficacy and safety of intranasal dexmedetomidine combined with midazolam in cranial magnetic resonance imaging of children. DESIGN A prospective, observational, single-arm, one-center study. METHODS A total of 474 children were scheduled for cranial 3.0 T MRI at the first time. All patients were initially given 3 mcg/kg dexmedetomidine combined with 0.15 mg/kg midazolam. The one-time success rate, vital signs before and after treatment, onset time, recovery time, and incidence of adverse reactions were recorded. FINDINGS The one-time success rate was 78.1%. There were significant differences in respiration, heart rate, and blood oxygen saturation before and after treatment (P < .001). The onset time was 10 (8-15) minutes. The average recovery time was 2.58 ± 1.10 hours. Only 1.27% (6 cases) of adverse reactions were observed, including bradycardia (3 cases, 0.6%), tachycardia (1 case, 0.2%), and startle (2 cases, 0.4%). No special treatment was needed. The success of the examination was significantly correlated with age (OR 1.320, 95% CI 1.019-1.710, P = .035) and onset time (OR 0.959, 95% CI 0.921-0.998, P = .038). CONCLUSION Dexmedetomidine 3 mcg/kg combined with midazolam 0.15 mg/kg intranasally has a good sedative effect in pediatric cranial magnetic resonance examinations, little impact on breathing and circulation, and few adverse reactions. Age and onset time are related factors affecting the one-time success rate.
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Affiliation(s)
- Si-Jie Li
- Department of Pediatrics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Kai-Feng Shen
- Department of Neurosurgery, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Li He
- Department of Pediatrics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yu-Ping Zhang
- Department of Pediatrics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Li Ming
- Department of Pediatrics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Zhi-Feng Wu
- Department of Pediatrics, Xinqiao Hospital, Army Medical University, Chongqing, China.
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Yu S, Liao J, Lin X, Luo Y, Lu G. Crucial role of autophagy in propofol-treated neurological diseases: a comprehensive review. Front Cell Neurosci 2023; 17:1274727. [PMID: 37946715 PMCID: PMC10631783 DOI: 10.3389/fncel.2023.1274727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/10/2023] [Indexed: 11/12/2023] Open
Abstract
Neurological disorders are the leading cause of disability and death globally. Currently, there is a significant concern about the therapeutic strategies that can offer reliable and cost-effective treatment for neurological diseases. Propofol is a widely used general intravenous anesthetic in the clinic. Emerging studies demonstrate that propofol exerts neuroprotective effects on neurological diseases and disorders, while its underlying pathogenic mechanism is not well understood. Autophagy, an important process of cell turnover in eukaryotes, has been suggested to involve in the neuroprotective properties developed by propofol. In this narrative review, we summarized the current evidence on the roles of autophagy in propofol-associated neurological diseases. This study highlighted the effect of propofol on the nervous system and the crucial roles of autophagy. According to the 21 included studies, we found that propofol was a double-edged sword for neurological disorders. Several eligible studies reported that propofol caused neuronal cell damage by regulating autophagy, leading to cognitive dysfunction and other neurological diseases, especially high concentration and dose of propofol. However, some of them have shown that in the model of existing nervous system diseases (e.g., cerebral ischemia-reperfusion injury, electroconvulsive therapy injury, cobalt chloride-induced injury, TNF-α-induced injury, and sleep deprivation-induced injury), propofol might play a neuroprotective role by regulating autophagy, thus improving the degree of nerve damage. Autophagy plays a pivotal role in the neurological system by regulating oxidative stress, inflammatory response, calcium release, and other mechanisms, which may be associated with the interaction of a variety of related proteins and signal cascades. With extensive in-depth research in the future, the autophagic mechanism mediated by propofol will be fully understood, which may facilitate the feasibility of propofol in the prevention and treatment of neurological disorders.
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Affiliation(s)
- Sicong Yu
- Department of Anesthesiology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
| | - Jian Liao
- Department of Nephrology, Jiaxing Hospital of Traditional Chinese Medicine, Jiaxing, China
| | - Xuezheng Lin
- Department of Anesthesiology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
| | - Yu Luo
- Department of Anesthesiology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
| | - Guangtao Lu
- Department of Anesthesiology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
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Angelopoulou VA, Pouliakis A, Alexiou N, Ioannidi P, Vagiona D, Ekmektzoglou K, Xanthos T, Boutsikou T, Iliodromiti Z, Iacovidou N. The Effects of Dexmedetomidine on Children Undergoing Magnetic Resonance Imaging: A Systematic Review and Meta-Analysis. CHILDREN (BASEL, SWITZERLAND) 2023; 10:948. [PMID: 37371178 DOI: 10.3390/children10060948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/30/2023] [Accepted: 05/24/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Magnetic Resonance Imaging (MRI) is a valuable diagnostic tool but often requires sedation to complete, especially in children. Dexmedetomidine (DEX) is an a2 agonist, for which there are experimental findings that support its potential neuroprotective effects. Given the potential risks of anesthetic drugs, we ran this study to examine DEX's effectiveness and cardiopulmonary safety as a sedative drug for children undergoing MRI. MATERIAL AND METHODS Systematic research was conducted in PubMed, Google Scholar, Scopus and Cochrane databases for randomized controlled trials published between 2010 and 6th/2022 and involving children undergoing MRI who received DEX as sedative medication. The records which met the including criteria, after indexing via the PRISMA chart and assessing for bias, were processed, and a meta-analysis was carried out with the random effects method. RESULTS Thirteen studies were included. Out of 6204 measurements obtained, in 4626, it was planned for the participants to only receive DEX (measure group) as an anesthetic drug throughout the procedure. The participants' mean age was 57 months (Ι2 = 4%, τ2 = 0.5317, p = 0.40). A total of 5.6% (95% CI: 0.6-14.1%, I2 = 98%, p < 0.01) of the patients needed a second dose of DEX. In total, 6% (95% CI: 1-15%, I2 = 93%, τ2 = 0.0454, p < 0.01) required the administration of another drug, besides DEX, to complete the imaging (sedation failure). The effectiveness of the only-DEX method was 99% (95% CI: 97.5-100%, I2 = 81%, τ2 = 0.0107, p < 0.01). The whole rate of adverse events was 15% (95% CI: 9.3-21.5%, I2 = 92%, p < 0.01). Hypotension was reported in 8.7% of the cases (95% CI: 3.1-16.4%, I2 = 84%, p < 0.01), hypertension in 1.1% (95% CI: 0-5.4%, I2 = 89%, p < 0.01), bradycardia in 10% (95% CI: 4-18%, I2 = 95%, p < 0.01) and desaturation in 1.2% (95% CI: 0-4%, I2 = 68%, p < 0.01). There was no statistically significant incidence in respiratory rate decrease (comparing the children who received DEX to their baseline). Five cases of vomiting and one of apnea were recorded. CONCLUSIONS Given that DEX seems to be an effective as well as respiratory and hemodynamically safe drug, it may be a future spotlight in (pediatric) sedation for imaging procedures such as MRI.
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Affiliation(s)
- Valentina-Anastasia Angelopoulou
- Department of Radiology, General Hospital of Elefsina "Thriasio", 19600 Attica, Greece
- Postgraduate Study Program (MSc) "Resuscitation", School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Abraham Pouliakis
- Second Department of Pathology, "Attikon" University Hospital, National and Kapodistrian University of Athens, 12464 Athens, Greece
| | - Nikolaos Alexiou
- First Department of Internal Medicine, General Hospital of Elefsina "Thriasio", 19600 Attica, Greece
| | - Parthena Ioannidi
- Department of Invasive Radiology, General Hospital of Athens "Evangelismos", 10676 Athens, Greece
- European Board of Interventional Radiology (EBIR), 1010 Vienna, Austria
| | - Dimitra Vagiona
- Primary Health Center of Nevrokopi, General Hospital of Drama, 66100 Drama, Greece
| | - Konstantinos Ekmektzoglou
- Postgraduate Study Program (MSc) "Resuscitation", School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
- School of Medicine, European University Cyprus, 2404 Nicosia, Cyprus
| | - Theodoros Xanthos
- School of Health Sciences, University of West Attica, 12243 Athens, Greece
| | - Theodora Boutsikou
- Department of Neonatology, "Aretaieio" Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Zoi Iliodromiti
- Department of Neonatology, "Aretaieio" Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Nikoletta Iacovidou
- Postgraduate Study Program (MSc) "Resuscitation", School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Department of Neonatology, "Aretaieio" Hospital, School of Medicine, National and Kapodistrian University of Athens, 11528 Athens, Greece
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Ekimov EV, Skripkina GI, Gaidomak KI. Special aspects of treatment and adaptation of children with autism spectrum disorder at a dental appointment (literature review). Pediatr Dent 2023. [DOI: 10.33925/1683-3031-2022-22-4-314-322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Relevance. Children with autism spectrum disorder (ASD) have poor self-care skills; they depend on sweet food, and their sensory integration is impaired. All of the above leads to poor oral hygiene. High rates of dental disease in these patients require searching for the most effective treatment and prevention methods. Special programs based on clinical manifestations and behaviour modification have been developed for children with ASD to adapt to dental appointments and oral hygiene education. In addition to traditional hygiene education, modern techniques, including electronic devices, are increasingly being introduced. Unfortunately, not all children can get used to dental manipulations, and the dentist has to resort to sedation or general anaesthes ia.Objective. To present up-to-date information about children's adaptation methods to dental appointments, prevention and treatment of oral diseases.Materials and methods. The literature analysis on the topic was the main study method. Publications were searched in the Medline PubMed and E-library databases by the keywords: 'treatment and prevention of diseases', 'children with ASD', 'adaptation' and 'hygiene education', according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.Results. The comprehensive approach to oral-disease treatment in children with ASD under general anaesthesia and sedation enables us to achieve excellent results with optimal comfort for both the patient and the pediatric dentist. The advantage of these methods is that the doctor can perform a larger volume of treatment and preventive measures during one visit.Conclusion. Children with autism need prevention and treatment of dental conditions. Available prevention programs need to be adapted to their disease and personality characteristics, using various methods of hygiene education.
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Chauhan R, Luthra A, Sethi S, Panda N, Meena SC, Bhatia V, Bloria SD. A Prospective Randomized Controlled Trial Using Propofol or Dexmedetomidine for Conscious Sedation in Pediatric Patients Undergoing Sclerotherapy. J Pediatr Neurosci 2021; 15:379-385. [PMID: 33936302 PMCID: PMC8078632 DOI: 10.4103/jpn.jpn_167_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/27/2020] [Accepted: 03/30/2020] [Indexed: 11/26/2022] Open
Abstract
Aim: Sodium tetradecyl sulfate (STS) sclerotherapy in pediatric patients is usually undertaken under sedation inside digital subtraction angiography (DSA) suite. These patients are day-care patients and need adequate sedation for small duration. We performed this study to compare propofol and dexmedetomidine as sedative agents in these patients. Materials and Methods: Seventy American Society of Anesthesiologists (ASA) physical status I patients scheduled to undergo sclerotherapy for low-flow venous malformations under sedation were randomized to be administered either dexmedetomidine (Group D) or propofol (Group P). In Group D, initially 2 µg/kg of dexmedetomidine was administered over 10min (or till attainment of a Ramsay sedation score [RSS] of 5), followed by an infusion at the rate of 0.3 µg/kg/h. In Group P, propofol 1mg/kg bolus followed by an infusion at 100 µg/kg/min was administered, titrated to an RSS of 5. We measured intraoperative heart rate, blood pressure, respiratory rate, duration of procedure, and incidence of arterial desaturation, bradycardia, and respiratory depression in the two groups. Results: All the patients in both groups completed the procedure. The mean anesthesia time was significantly longer in Group D. Intraoperative heart rates remained comparable in the two groups, whereas systolic and diastolic BP were significantly higher in Group D throughout the procedure. No patient in Group D experienced arterial desaturation, whereas five patients in Group P reported a SpO2 of <90%. Conclusion: Both propofol and dexmedetomidine can be used for administering sedation in pediatric patients undergoing sclerotherapy for superficial venous malformations in DSA suite. Although propofol provides a rapid onset and reduced duration of action, dexmedetomidine provides reduced episodes of arterial desaturation and respiratory depression.
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Affiliation(s)
- Rajeev Chauhan
- Department of Anaesthesia, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Ankur Luthra
- Department of Anaesthesia, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Sameer Sethi
- Department of Anaesthesia, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Nidhi Panda
- Department of Anaesthesia, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Shyam Charan Meena
- Department of Anaesthesia, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Vikas Bhatia
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Summit D Bloria
- Department of Anaesthesia, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
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Dexmedetomidine: What's New for Pediatrics? A Narrative Review. J Clin Med 2020; 9:jcm9092724. [PMID: 32846947 PMCID: PMC7565844 DOI: 10.3390/jcm9092724] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/17/2020] [Accepted: 07/28/2020] [Indexed: 02/07/2023] Open
Abstract
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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Mason KP, Seth N. The pearls of pediatric sedation: polish the old and embrace the new. Minerva Anestesiol 2019; 85:1105-1117. [PMID: 31124622 DOI: 10.23736/s0375-9393.19.13547-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Over the past decade, as the complexity and breadth of pediatric procedures increases, the actual choices of approved sedatives have remained relatively stagnant. Since the introduction of midazolam, there has not been a sedative approved for pediatric labelling until December 2018. This December, the European approval of ADV6209 (Ozalin) for pediatric usage marked the newest addition to the pediatric sedative armamentarium in over a decade. This review is timely and significant because it will provide a balanced evaluation of the most common sedatives in use today, the most recent sedative to be approved and, most importantly, a critical look at the literature supporting the latest approaches to the most commonly performed procedures.
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Affiliation(s)
- Keira P Mason
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA -
| | - Neena Seth
- Evelina London Children's Hospital, London, UK
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