Intranasal Dexmedetomidine as a Sedative for Pediatric Procedural Sedation

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Natalie Behrle, MD, MS; Esma Birisci, MA; Jordan Anderson, PharmD; Sara Schroeder;
and Abdallah Dalabih, MD, MBA

OBJECTIVE This study seeks to evaluate the efficacy and safety of intranasal (IN) dexmedetomidine as a sedative medication for non-invasive procedural sedation. METHODS Subjects 6 months to 18 years of age undergoing non-invasive elective procedures were included. Dexmedetomidine (3 mcg/kg) was administered IN 40 minutes before the scheduled procedure time. The IN dexmedetomidine cohort was matched and compared to a cohort of 690 subjects who underwent sedation for similar procedures without the use of dexmedetomidine to evaluate for observed events/interventions and procedural times.

RESULTS One hundred (92%) of the 109 included subjects were successfully sedated with IN dexmedetomidine. There were no significant differences in the rate of observed events/interventions in comparison to the non-dexmedetomidine cohort. However, the IN dexmedetomidine group had a longer postprocedure sleep time when compared to the non-dexmedetomidine cohort (p < 0.001), which had a significant effect on recovery time (p = 0.024). Also, the dexmedetomidine cohort had longer procedure time and total admit time (p < 0.001 and p = 0.037, respectively).

CONCLUSIONS IN dexmedetomidine may be used for non-invasive pediatric procedural sedation. Subjects receiving IN dexmedetomidine had a similar rate of observed events/interventions as the subjects receiving non-dexmedetomidine sedation, with the exception of sleeping time. Also, patients sedated with IN dexmedetomidine had longer time to discharge, procedure time, and total admit time in comparison to other forms of sedation.

ABBREVIATIONS ASA score, American Society of Anesthesiologists physical status score; DEX, dexmedetomidine; IN, intranasal; PSA, procedural sedation and analgesia KEYWORDS alpha 2-adrenoreceptor agonist; dexmedetomidine; drugs; hypnotic; imidazole; intranasal; Precedex

Introduction
The importance of procedural sedation and analgesia
(PSA) for children undergoing procedures and imaging
studies has led to an increase in demand for sedation
outside of the operating room. Due to this demand, the
role of pediatric critical care providers, hospitalists, and
emergency physicians has also expanded to include
PSA.1
For sedation providers outside of the operating
room, dexmedetomidine (DEX) offers a safety profile
similar to traditional sedatives (i.e., ketamine and midazolam) and has been reported to be efficacious when
administered intranasally (IN).2-7
DEX is a highly selective and potent agonist at the
α2-adrenoreceptor, with sedative, anxiolytic, and analgesic effects.8 The sedative properties of DEX are
largely due to effects on the locus ceruleus, producing a level of consciousness mimicking natural sleep.9
DEX administered intravenously for sedation in the
intensive care unit and non-invasive procedures is well established.10-15 IN administration of DEX is advantageous, as it is less invasive and anxiety provoking for
the pediatric population. Additional data suggest that
when compared to intravenously administrated DEX,
IN DEX has a significantly lower risk of respiratory
depression and hemodynamic changes.16 Moreover,
IN DEX has the same success rate when compared to
IN midazolam and ketamine.4
In this study, we hypothesized that IN DEX is effective in providing adequate sedation for non-invasive
procedures. Our primary objective was to evaluate
the efficacy of IN DEX as a sedative medication. Our
secondary objective was to evaluate the safety profile
of IN DEX compared to well-established intravenous
sedative medications (i.e., midazolam, propofol, pentobarbital, and ketamine).

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