Elsevier

The Journal of Pediatrics

Volume 166, Issue 5, May 2015, Pages 1313-1315.e1
The Journal of Pediatrics

Clinical and Laboratory Observations
Intranasal Dexmedetomidine for Sedation for Pediatric Computed Tomography Imaging

https://doi.org/10.1016/j.jpeds.2015.01.036Get rights and content

This prospective observational pilot study evaluated the aerosolized intranasal route for dexmedetomidine as a safe, effective, and efficient option for infant and pediatric sedation for computed tomography imaging. The mean time to sedation was 13.4 minutes, with excellent image quality, no failed sedations, or significant adverse events.

Trial registration

Registered with ClinicalTrials.gov: NCT01900405.

Section snippets

Methods

After Institutional Review Board approval and parental consent, children who presented to the Emergency Department in need of a CT imaging study and who met enrollment criteria (aged 1 month to 5 years; no need for or presence of an IV catheter; lies supine without clinical evidence of vomiting, reflux, or aspiration; ASA [American Society of Anesthesiologists] 1 or ASA 2) and without contraindications for DEX therapy7 (Table I) were recruited in a convenience sample by the principal

Results

Between June and December 2013, 60 patients (56.7% males; 80% ASA 1 and 20% ASA 2) underwent a total of 63 CT studies (82.5% head scans). Mean age was 17.1 ± 9.5 months (median, 15.0 months; range, 3.0-43.0 months) and mean weight was 10.7 ± 2.8 kg (median, 10.0 kg, range, 5.0-19.5 kg) (Table IV). Breast milk, infant formula, and full meals were most frequently reported as the last meal (20%, 23.3%, and 43.3%, respectively). The average NPO time was 206.3 ± 123.6 minutes (median, 185.5 minutes;

Discussion

DEX is unique as a sedative that preserves respiratory measurements and creates a natural state of non–rapid eye movement sleep.13, 14, 15 It has been successfully administered via the IV and intramuscular routes for pediatric radiologic imaging.7, 16, 17, 18 To date, however, the literature does not describe sedation via the intranasal route with aerosolized DEX for pediatric CT.5, 16

The intranasal route has been described for perioperative anxiolysis.19, 20, 21, 22 In adults, there is up to

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      2021, American Journal of Emergency Medicine
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      Dexmedetomidine's use is limited by its known side effects of hypotension and bradycardia. It has the benefits of intranasal administration which is desirable especially in patients who do not require an IV for other purposes [7,16]. Unfortunately, dexmedetomidine has a long duration of action which can prolong ED stay.

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      However, intranasal administration by nasal dropping is more convenient and quicker than the atomization method. Previous studies have reported that intranasal DEX as a sedative is suitable for CT, MRI and transthoracic echocardiography (TTE) with fewer side effects [10–12]. The use of intranasal DEX for PFT in children aged 1–3 years has not been well described in the literature.

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    The authors declare no conflicts of interest.

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