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Peganc Nunčič K, Neubauer D, Oražem Mrak J, Perković Benedik M, Mahne U, Bizjak N, Rener Primec Z, Šuštar N, Butenko T, Vrščaj E, Osredkar D. Melatonin vs. dexmedetomidine for sleep induction in children before electroencephalography. Front Pediatr 2024; 12:1362918. [PMID: 38725985 PMCID: PMC11079286 DOI: 10.3389/fped.2024.1362918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 03/05/2024] [Indexed: 05/12/2024] Open
Abstract
Background and objectives In children requiring electroencephalography (EEG), sleep recording can provide crucial information. As EEG recordings during spontaneous sleep are not always possible, pharmacological sleep-inducing agents are sometimes required. The aim of the study was to evaluate safety and efficacy of melatonin (Mel) and dexmedetomidine (Dex; intranasal and sublingual application) for sleep induction prior to EEG. Methods In this prospective randomized study, 156 consecutive patients aged 1-19 years were enrolled and randomized by draw into melatonin group (Mel; n = 54; dose: 0.1 mg/kg), dexmedetomidine (Dex) sublingual group (DexL; n = 51; dose: 3 mcg/kg) or dexmedetomidine intranasal group (DexN; n = 51; dose: 3 mcg/kg). We compared the groups in several parameters regarding efficacy and safety and also carried out a separate analysis for a subgroup of patients with complex behavioral problems. Results Sleep was achieved in 93.6% of participants after the first application of the drug and in 99.4% after the application of another if needed. Mel was effective as the first drug in 83.3% and Dex in 99.0% (p < 0.001); in the subgroup of patients with complex developmental problems Mel was effective in 73.4% and Dex in 100% (p < 0.001). The patients fell asleep faster after intranasal application of Dex than after sublingual application (p = 0.006). None of the patients had respiratory depression, bradycardia, desaturation, or hypotension. Conclusions Mel and Dex are both safe for sleep induction prior to EEG recording in children. Dex is more effective compared to Mel in inducing sleep, also in the subgroup of children with complex behavioral problems. Clinical Trial Registration Dexmedetomidine and Melatonin for Sleep Induction for EEG in Children, NCT04665453.
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Affiliation(s)
- Katja Peganc Nunčič
- Department of Pediatric Neurology, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - David Neubauer
- Department of Pediatric Neurology, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, Center for Developmental Neuroscience, University of Ljubljana, Ljubljana, Slovenia
| | - Jasna Oražem Mrak
- Department of Pediatric Neurology, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Mirjana Perković Benedik
- Department of Pediatric Neurology, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, Center for Developmental Neuroscience, University of Ljubljana, Ljubljana, Slovenia
| | - Urška Mahne
- Department of Pediatric Intensive Care, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Neli Bizjak
- Department of Pediatric Neurology, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Zvonka Rener Primec
- Department of Pediatric Neurology, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, Center for Developmental Neuroscience, University of Ljubljana, Ljubljana, Slovenia
| | - Nataša Šuštar
- Department of Pediatric Neurology, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Tita Butenko
- Department of Pediatric Neurology, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Eva Vrščaj
- Department of Pediatric Neurology, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Damjan Osredkar
- Department of Pediatric Neurology, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, Center for Developmental Neuroscience, University of Ljubljana, Ljubljana, Slovenia
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Wyness B, Crook J, D'Silva P, McCormick D. Chloral hydrate - use as a sedative in paediatric settings. Arch Dis Child Educ Pract Ed 2023; 108:445-449. [PMID: 37495268 DOI: 10.1136/archdischild-2022-324939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/11/2023] [Indexed: 07/28/2023]
Affiliation(s)
- Benjamin Wyness
- Pharmacy Department, King's College Hospital NHS Foundation Trust, London, UK
| | - Joanne Crook
- Pharmacy Department, King's College Hospital NHS Foundation Trust, London, UK
| | - Pam D'Silva
- Paediatric Intensive Care Unit, Variety Children's Hospital, Kings College Hospital NHS Foundation Trust, London, UK
| | - David McCormick
- Paediatric Neurosciences, Variety Children's Hospital, Kings College Hospital NHS Foundation Trust, London, UK
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Gu H, Miao L, Bai J, Lu G, Lei Q, Yang L, Wang D. Combined use of intranasal Dexmedetomidine and an oral novel formulation of Midazolam for sedation of young children during brain MRI examination: a prospective, single-center, randomized controlled trial. BMC Anesthesiol 2022; 22:357. [PMID: 36418946 PMCID: PMC9685922 DOI: 10.1186/s12871-022-01897-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 11/07/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND To evaluate the safety and effectiveness of different dosages of intranasal Dexmedetomidine (DEX) in combination with oral midazolam for sedation of young children during brain MRI examination. METHODS Included in this prospective single-blind randomized controlled trial were 156 children aged from 3 months to 6 years and weighing from 4 to 20 Kg with ASA I-II who underwent brain MRI examination between March 2021 and February 2022. Using the random number table method, they were divided into group A (using 3 ug/kg intranasal DEX plus 0.2 mg/Kg oral midazolam) and group B (using 2 ug/kg intranasal DEX plus 0.2 mg/Kg oral Midazolam). The one-time success rate of sedation, sedation onset time, recovery time, overall sedation time, and occurrence of adverse reactions during MRI examination were compared between the two groups. The heart rate (HR), mean arterial pressure (MAP), and percutaneous SpO2before and after drug administration were observed in both groups. Differences in sedation scores between the two groups were compared before intranasal drug administration (T0), 10 min after drug administration (T1), at the time of falling asleep (T2), at the end of examination (T3), and at the time of recovery (T4). RESULTS The one-time success rate of sedation in group A and B was 88.31% and 79.75% respectively, showing no significant difference between the two groups (P>0.05). The sedation onset time in group A was 24.97±16.94 min versus 27.92±15.83 min in group B, and the recovery time was 61.88±22.18 min versus 61.16±28.16 min, both showing no significance difference between the two groups (P>0.05). Children in both groups exhibited good drug tolerance without presenting nausea and vomiting, hypoxia, or bradycardia and hypotension that needed clinical interventions. There was no significant difference in the occurrence of abnormal HR, MAP or other adverse reactions between the two groups (P>0.05). CONCLUSION 3 ug/kg or 2 ug/kg intranasal DEX in combination with 0.2 mg/kg oral Midazolam both are safe and effective for sedation of children undergoing MRI examination with the advantages of fast-acting and easy application. TRIAL REGISTRATION It was registered at the Chinese Clinical Trial Registry ( ChiCTR1800015038 ) on 02/03/2018.
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Affiliation(s)
- Hongbin Gu
- grid.16821.3c0000 0004 0368 8293Department of Anesthesiology, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China ,grid.256112.30000 0004 1797 9307Department of Anesthesiology, Fujian Children’s Hospital (Fujian Branch of Shanghai Children’s Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Liyan Miao
- grid.256112.30000 0004 1797 9307Department of Anesthesiology, Fujian Children’s Hospital (Fujian Branch of Shanghai Children’s Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China ,grid.256112.30000 0004 1797 9307Department of Anesthesiology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Jie Bai
- grid.16821.3c0000 0004 0368 8293Department of Anesthesiology, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China ,grid.256112.30000 0004 1797 9307Department of Anesthesiology, Fujian Children’s Hospital (Fujian Branch of Shanghai Children’s Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Guolin Lu
- grid.256112.30000 0004 1797 9307Department of Anesthesiology, Fujian Children’s Hospital (Fujian Branch of Shanghai Children’s Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China ,grid.256112.30000 0004 1797 9307Department of Anesthesiology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Qian Lei
- grid.256112.30000 0004 1797 9307Department of Anesthesiology, Fujian Children’s Hospital (Fujian Branch of Shanghai Children’s Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Lijun Yang
- grid.256112.30000 0004 1797 9307Department of Anesthesiology, Fujian Children’s Hospital (Fujian Branch of Shanghai Children’s Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China ,grid.256112.30000 0004 1797 9307Department of Anesthesiology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Denggui Wang
- grid.256112.30000 0004 1797 9307Department of Anesthesiology, Fujian Children’s Hospital (Fujian Branch of Shanghai Children’s Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China ,grid.256112.30000 0004 1797 9307Department of Anesthesiology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
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Li BL, Luo H, Huang JX, Zhang HH, Paquin JR, Yuen VM, Song XR. Using intranasal dexmedetomidine with buccal midazolam for magnetic resonance imaging sedation in children: A single-arm prospective interventional study. Front Pediatr 2022; 10:889369. [PMID: 35989987 PMCID: PMC9386185 DOI: 10.3389/fped.2022.889369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 07/06/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Although numerous intravenous sedative regimens have been documented, the ideal non-parenteral sedation regimen for magnetic resonance imaging (MRI) has not been determined. This prospective, interventional study aimed to investigate the efficacy and safety of buccal midazolam in combination with intranasal dexmedetomidine in children undergoing MRI. METHODS Children between 1 month and 10 years old requiring sedation for MRI examination were recruited to receive buccal midazolam 0.2 mg⋅kg-1 with intranasal dexmedetomidine 3 μg⋅kg-1. The primary outcome was successful sedation following the administration of the initial sedation regimens and the completion of the MRI examination. RESULTS Sedation with dexmedetomidine-midazolam was administered to 530 children. The successful sedation rate was 95.3% (95% confidence interval: 93.5-97.1%) with the initial sedation regimens and 97.7% (95% confidence interval: 96.5-99%) with a rescue dose of 2 μg⋅kg-1 intranasal dexmedetomidine. The median sedation onset time was 10 min, and a significant rising trend was observed in the onset time concerning age (R = 0.2491, P < 0.001). The wake-up and discharge times significantly correlated with the duration of the procedure (R = 0.323, P < 0.001 vs. R = 0.325, P < 0.001). No oxygen deficiency nor medication intervention due to cardiovascular instability was observed in any of the patients. History of a prior failed sedation was considered a statistically significant risk factor for failed sedation in the multivariate logistic regression model [odds ratio = 4.71 (95% confidence interval: 1.24-17.9), P = 0.023]. CONCLUSION In MRI examinations, the addition of buccal midazolam to intranasal dexmedetomidine is associated with a high success rate and a good safety profile. This non-parenteral sedation regimen can be a feasible and convenient option for short-duration MRI in children between 1 month and 10 years.
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Affiliation(s)
- Bi Lian Li
- Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Hao Luo
- Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jun Xiang Huang
- Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Huan Huan Zhang
- Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Joanna R Paquin
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Vivian M Yuen
- Department of Anesthesiology and Perioperative Medicine, Hong Kong Children's Hospital, Hong Kong, Hong Kong SAR, China
| | - Xing Rong Song
- Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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