Prospective evaluation of dexmedetomidine for noninvasive procedural sedation in children*


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Abstract

Objective:Children often require sedation for lengthy noninvasive procedures. Conventional agents such as chloral hydrate, benzodiazepines, or barbiturates have been associated with sedation failure, respiratory depression, and paradoxic agitation. Dexmedetomidine is a newer α2-adrenergic receptor agonist with sedative properties and minimal respiratory depression. We hypothesized that it would be an effective agent for these procedures.Design:Prospective case series.Setting:Tertiary care children’s hospital.Patients:Children undergoing noninvasive procedures.Interventions:Children were sedated with dexmedetomidine given as a bolus of 0.5–1.0 μg/kg over 5–10 mins followed by an infusion of 0.5–1.0 μg/kg/hr. Vital signs, sedative effectiveness, recovery patterns, and complications were prospectively recorded.Measurements and Main Results:Forty-eight patients, aged 6.9 ± 3.7 yrs, were sedated. Fifteen received dexmedetomidine after failing sedation with chloral hydrate and/or midazolam. Sedation was induced with 0.92 ± 0.36 μg/kg over 10.3 ± 4.7 mins and maintained with an infusion of 0.69 ± 0.32 μg/kg/hr. All procedures were completed. Heart rate, blood pressure, and respiratory rate decreased (p < .0001) but remained within normal limits for age. End-tidal CO2 exceeded 50 mm Hg in seven of 404 measurements (1.7%). Mean recovery time was 84 ± 42 mins and was significantly longer in the rescue (117 ± 41 mins) vs. primary (69 ± 34 mins) group (p < .0001). No patient developed agitation during recovery.Conclusions:Dexmedetomidine provided effective sedation in children undergoing noninvasive procedures and represents an alternative sedative choice for this population.

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