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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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Cui Y, Gong T, Mu Q, Wu Q, Kang L, Chen Q, He Y. Predictors of pediatric sedation failure with initial dose of intranasal dexmedetomidine and oral midazolam. Pediatr Res 2023; 94:2054-2061. [PMID: 37507474 DOI: 10.1038/s41390-023-02758-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/09/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND To assess the sedative failure rate over different dose combinations of intranasal dexmedetomidine and oral midazolam for procedural sedation. METHODS This was a retrospective study. Four groups were established according to the initial dose of sedatives. The primary outcome was the sedative failure rate for different doses of the two-drug combination. The risk factors associated with sedation failure were analyzed. RESULTS A total of 2165 patients were included in the final analysis. Of these, 394 children were classified as sedation failure after the initial dose of a combination of intranasal dexmedetomidine and oral midazolam. Although the initial doses of intranasal dexmedetomidine and oral midazolam administered to patients varied widely, no significant differences were detected in the sedation outcomes among the groups. Multivariate analysis showed that sedation history, a history of sedation failure, and echocardiography were independent risk factors for sedation failure after an initial dose of intranasal dexmedetomidine and oral midazolam. In contrast, patients undergoing lung function and MRI were more likely to be successfully sedated. CONCLUSION A combination of low-dose intranasal dexmedetomidine and oral midazolam provides adequate sedation efficacy without any increase in side effects, especially for patients undergoing MRI or lung function examination. IMPACT This is an original article about the risk factors of sedation failure with an initial dose of intranasal dexmedetomidine and oral midazolam for procedure sedation. For patients undergoing echocardiogram, it is better to choose other sedatives, while a combination of intranasal dexmedetomidine and oral midazolam is a good option for patients undergoing MRI or lung function. The selection of sedative drugs should be personalized according to different procedures.
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Affiliation(s)
- Yu Cui
- Department of Anesthesiology, The Affiliated Hospital, School of Medicine, UESTC Chengdu Women's & Children's Central Hospital, Chengdu, 610091, China.
| | - Tianqing Gong
- Department of Anesthesiology, The Affiliated Hospital, School of Medicine, UESTC Chengdu Women's & Children's Central Hospital, Chengdu, 610091, China
| | - Qixia Mu
- Department of Anesthesiology, The Affiliated Hospital, School of Medicine, UESTC Chengdu Women's & Children's Central Hospital, Chengdu, 610091, China
| | - Qunying Wu
- Department of Anesthesiology, The Affiliated Hospital, School of Medicine, UESTC Chengdu Women's & Children's Central Hospital, Chengdu, 610091, China
| | - Lu Kang
- Department of Anesthesiology, The Affiliated Hospital, School of Medicine, UESTC Chengdu Women's & Children's Central Hospital, Chengdu, 610091, China
| | - Qin Chen
- Department of Anesthesiology, The Affiliated Hospital, School of Medicine, UESTC Chengdu Women's & Children's Central Hospital, Chengdu, 610091, China
| | - Yani He
- Department of Anesthesiology, The Affiliated Hospital, School of Medicine, UESTC Chengdu Women's & Children's Central Hospital, Chengdu, 610091, China
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Goyens E, Allegaert K, De Buck F, Lauweryns J, Toelen J, Vanhonsebrouck K. Nurse-driven intranasal dexmedetomidine administration as sedation for non-invasive procedures in children: a single centre audit. Eur J Pediatr 2023; 182:899-905. [PMID: 36517626 DOI: 10.1007/s00431-022-04722-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 10/30/2022] [Accepted: 11/17/2022] [Indexed: 12/23/2022]
Abstract
UNLABELLED The purpose of this study is to audit the efficacy and safety of intranasal dexmedetomidine sedation for non-invasive procedural sedation in children provided by nurses of the procedural sedation (PROSA) team in the University Hospitals Leuven. Efficacy (successful sedation as sole sedative) and safety (cardiorespiratory monitoring, saturation) were assessed. In this audit, prospectively recorded data were extracted from the medical files in 772 patients between 4 weeks to 18 years old, who underwent sedation with intranasal dexmedetomidine (2-4 µg/kg) by the nurse-driven PROSA team, following pre-screening on risk factors. Ninety-one percent of the patients were successfully sedated (single dose, monotherapy), 60 patients (7.8%) needed an additional intervention during sedation, 37 (4.8%) needed an extra dose of intranasal dexmedetomidine, and 14 (1.8%) received an additional other sedative. Successful sedation rates were higher in younger children, and medical imaging was the most common indication. Sedation failed in 12 (1.6%) patients, with 10 of them failed to fall asleep. Adverse events were limited in number (n = 13, 1.7%) and severity: 4 patients had a low heart rate (one received atropine), one had an irregular heart rate, and 7 desaturation events were described. Hypotension was treated with normal saline in one case. CONCLUSIONS In this nurse-driven PROSA setting, intranasal dexmedetomidine is effective and safe for non-invasive procedural sedation in an a priori low risk group of paediatric patients. WHAT IS KNOWN • Procedural sedation outside the operating theatre or intensive care units is increasingly used, including sedation performed by non-anaesthesiologists or nurses. This resulted in the development of procedural sedation and analgesia (PROSA) teams. • Off-label use of intranasal dexmedetomidine in children is increasing, with a limited number of audits on this practice, its safety and efficacy. WHAT IS NEW • In an audit on 772 procedures, nurse-driven intranasal dexmedetomidine administration as sedation for non-invasive procedures in children within a structured framework was safe and effective. • Imaging (CT, MRI) was the most common procedural indication in our study, but also nuclear imaging techniques were included.
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Affiliation(s)
- Emma Goyens
- Faculty of Medicine, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Karel Allegaert
- Child and Youth Institute, KU Leuven, Herestraat 49, 3000, Leuven, Belgium. .,Department of Development and Regeneration, KU Leuven, 3000, Leuven, Belgium. .,Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, 3000, Leuven, Belgium. .,Department of Hospital Pharmacy, Erasmus MC, 3000 GA, Rotterdam, the Netherlands.
| | - Frederik De Buck
- Department of Anaesthesia, University Hospitals UZ, Leuven, Belgium.,Department of Cardiovascular Sciences, Anaesthesia and Algology, KU Leuven, Leuven, Belgium
| | - Julie Lauweryns
- Department of Anaesthesia, University Hospitals UZ, Leuven, Belgium.,Department of Cardiovascular Sciences, Anaesthesia and Algology, KU Leuven, Leuven, Belgium
| | - Jaan Toelen
- Child and Youth Institute, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven, 3000, Leuven, Belgium.,Department of Paediatrics, University Hospitals UZ Leuven, 3000, Leuven, Belgium
| | - Koen Vanhonsebrouck
- Department of Paediatrics, University Hospitals UZ Leuven, 3000, Leuven, Belgium
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de Rover I, Wylleman J, Dogger JJ, Bramer WM, Hoeks SE, de Graaff JC. Needle-free pharmacological sedation techniques in paediatric patients for imaging procedures: a systematic review and meta-analysis. Br J Anaesth 2023; 130:51-73. [PMID: 36283870 DOI: 10.1016/j.bja.2022.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 08/15/2022] [Accepted: 09/06/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Sedation techniques and drugs are increasingly used in children undergoing imaging procedures. In this systematic review and meta-analysis, we present an overview of literature concerning sedation of children aged 0-8 yr for magnetic resonance imaging (MRI) procedures using needle-free pharmacological techniques. METHODS Embase, MEDLINE, Web of Science, and Cochrane databases were systematically searched for studies on the use of needle-free pharmacological sedation techniques for MRI procedures in children aged 0-8 yr. Studies using i.v. or i.m. medication or advanced airway devices were excluded. We performed a meta-analysis on sedation success rate. Secondary outcomes were onset time, duration, recovery, and adverse events. RESULTS Sixty-seven studies were included, with 22 380 participants. The pooled success rate for oral chloral hydrate was 94% (95% confidence interval [CI]: 0.91-0.96); for oral chloral hydrate and intranasal dexmedetomidine 95% (95% CI: 0.92-0.97); for rectal, oral, or intranasal midazolam 36% (95% CI: 0.14-0.65); for oral pentobarbital 99% (95% CI: 0.90-1.00); for rectal thiopental 92% (95% CI: 0.85-0.96); for oral melatonin 75% (95% CI: 0.54-0.89); for intranasal dexmedetomidine 62% (95% CI: 0.38-0.82); for intranasal dexmedetomidine and midazolam 94% (95% CI: 0.78-0.99); and for inhaled sevoflurane 98% (95% CI: 0.97-0.99). CONCLUSIONS We found a large variation in medication, dosage, and route of administration for needle-free sedation. Success rates for sedation techniques varied between 36% and 98%.
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Affiliation(s)
- Ingeborg de Rover
- Department of Anaesthesiology, Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Jasper Wylleman
- Department of Anaesthesiology, Sophia Children's Hospital, Rotterdam, the Netherlands; Department of Anaesthesiology and Perioperative Medicine, UZ Brussel, Brussels, Belgium
| | - Jaap J Dogger
- Department of Anaesthesiology, Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Wichor M Bramer
- Medical Library, Erasmus MC, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Sanne E Hoeks
- Department of Anaesthesiology, Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Jurgen C de Graaff
- Department of Anaesthesiology, Sophia Children's Hospital, Rotterdam, the Netherlands.
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Sedation with Intranasal Dexmedetomidine in the Pediatric Population for Auditory Brainstem Response Testing: Review of the Existing Literature. Healthcare (Basel) 2022; 10:healthcare10020287. [PMID: 35206901 PMCID: PMC8872591 DOI: 10.3390/healthcare10020287] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/28/2022] [Accepted: 01/30/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Intranasal dexmedetomidine (IN DEX) is a relatively new sedative agent with supporting evidence on its efficacy and safety, which can be used for procedural sedation in children, and could have a major role in auditory brainstem response testing, especially in the case of non-cooperative children. The goal of this systematic review is to assess the role of IN DEX in ABR testing, evaluating the reported protocol, potential, and limits. Methods: We performed a comprehensive search strategy on PubMed, Scopus, and Google Scholar, including studies in English on the pediatric population, without time restrictions. Results: Six articles, published between 2016 and 2021, were included in the systematic review. Sedation effectiveness was high across the studies, except for one study; 3 μg/kg was the dosing most often used. A comparison group was present in three studies, with oral chloral hydrate as the drug of comparison. Adverse effects were rarely reported. Conclusion: This systematic review showed how IN DEX can represent an adequate sedative for children undergoing ABR testing; larger and more rigorous trials are warranted in order to recommend its systematic utilization.
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