ABSTRACT
OBJECTIVES: To describe the efficacy and outcome of dexmedetomidine (Dex) via the intramuscular (IM) route for sedation for electroencephalography (EEG). STUDY DESIGN: Quality assurance data and EEG studies were reviewed for consecutive patients who received IM Dex for EEGs between August 2007 and September 2009. Sleep spindles, delta waves, and beta activity were evaluated to determine the deepest stage of sleep achieved. RESULTS: One hundred seven consecutive children (age 0.2-17 years) between August 2007 and September 2009 received IM Dex (range 1.0-4.5 mcg/kg). The average time to achieve sedation was 15.5 minutes (range 3.0-55.0) with an average of 54.5 minutes to meet discharge criteria following EEG studies, which averaged 34.2 ± 22.6 minutes. The deepest stage of sleep recorded for each child was: awake (n = 1), stage N2 (n = 51), and stage N3 (n = 55). Excessive beta activity was seen in only 1 patient. Epileptiform activity was noted in 11 patients. Hemodynamic fluctuations in heart rate and blood pressure were noted, none of which required pharmacologic intervention. All EEGs were successfully completed. CONCLUSION: We describe Stage 3 sleep and preserved background activity in response to Dex. We present the IM route as a new method, which preserves background EEG activity to provide safe and effective sedation for EEG studies.
Subject(s)
Deep Sedation/methods , Dexmedetomidine/administration & dosage , Electroencephalography/methods , Injections, Intramuscular/methods , Adolescent , Blood Pressure/drug effects , Child , Child, Preschool , Female , Heart Rate/drug effects , Humans , Hypnotics and Sedatives/pharmacology , Infant , Infant, Newborn , Male , Pediatrics/methods , Sleep , Sleep StagesABSTRACT
OBJECTIVE: Although dexmedetomidine has been administered to adults by intramuscular injection for perioperative anxiolysis and sedation, this route in children has not been described, to our knowledge. Our hypothesis was that intramuscular dexmedetomidine can be used to achieve sedation for MRI and CT of children. MATERIALS AND METHODS: The quality assurance data on all children who consecutively received intramuscular dexmedetomidine between August 1, 2007, and September 30, 2009, were reviewed. A single or repeated doses of 1-4 αg/kg intramuscular dexmedetomidine had been administered to achieve a minimum Ramsay sedation score of 4. Patient demographics, medical diagnosis, vital signs, adverse events, and outcome measures were reviewed. RESULTS: Sixty-five children received consecutive intramuscular dexmedetomidine injections and successfully completed imaging studies. The MRI group received a total mean of 2.9 αg/kg dexmedetomidine, and the CT group received a mean of 2.4 αg/kg (p ≤ 0.01). There was no statistically significant relation between the total dose of dexmedetomidine received, mean time to achieve sedation (13.1-13.4 minutes), or time to meet discharge criteria after arrival in the recovery unit (17.1-21.9 minutes). Nine patients (14%) experienced hypotension, defined as a decrease in blood pressure to less than 20% of the age-adjusted awake normal value. The dosage of dexmedetomidine was not a predictor of hypotension. None of the patients had bradycardia, hypertension, or oxygen desaturation. CONCLUSION: The intramuscular route is an alternative approach to dexmedetomidine delivery for pediatric sedation. Larger studies are warranted to evaluate the efficacy, safety, and hemodynamic outcome associated with the intramuscular use of dexmedetomidine in the care of children.
Subject(s)
Conscious Sedation/methods , Dexmedetomidine/administration & dosage , Hypnotics and Sedatives/administration & dosage , Magnetic Resonance Imaging , Tomography, X-Ray Computed , Child , Child, Preschool , Female , Humans , Infant , Injections, Intramuscular , MaleABSTRACT
Dexmedetomidine has been increasingly in use for pediatric noninvasive procedural sedation. This retrospective study examined experience in children with autism and other neurobehavioral disorders, populations often difficult to sedate. Records of children with autism or neurobehavioral disorders sedated with dexmedetomidine at Chris Evert Children's Hospital and Kosair Children's Hospital were reviewed. Demographic and sedation-related data were collected, including sedative doses, time to sedation, efficacy, and complications. Comparisons of sedative doses, efficacy between autism and neurobehavioral patients, and analysis of age-related factors were performed. In all, 315 patients were sedated, most commonly for magnetic resonance imaging. Mean induction and total dexmedetomidine doses were 1.4 +/- 0.6 and 2.6 +/- 1.6 microg/kg, respectively, with no differences between autism and neurobehavior patients. Most patients (90%) patients received concomitant midazolam. There was an age-related decrease in dexmedetomidine dose, independent of midazolam use. Seven patients required intervention for hypotension, bradycardia, or both, and only one adverse respiratory event (obstruction requiring nasopharyngeal airway placement) occurred. There were two episodes of overt recovery-related agitation. All but four procedures were successfully completed (4/315, or 98.7%). Dexmedetomidine with or without midazolam was an effective sedative in this population. The regimen appeared to be well tolerated with few adverse events, including recovery-related agitation, and appears to be an attractive option for this population.
Subject(s)
Autistic Disorder , Dexmedetomidine , Hypnotics and Sedatives , Mental Disorders , Adolescent , Age Factors , Child , Child, Preschool , Conscious Sedation , Dexmedetomidine/administration & dosage , Dexmedetomidine/adverse effects , Follow-Up Studies , Humans , Hypnotics and Sedatives/administration & dosage , Hypnotics and Sedatives/adverse effects , Infant , Interviews as Topic , Linear Models , Midazolam , Patient Satisfaction , Retrospective Studies , Young AdultABSTRACT
BACKGROUND: In Fall 2003, Chris Evert Children's Hospital (CECH; Fort Lauderdale, Florida) exclusively used chloral hydrate for moderate sedation. As procedures became longer and more complex, pentobarbital became the primary sedative used. Yet children receiving pentobarbital were awakening during the procedure from paradoxical drug reactions or insufficient sedation. In 2003, the failed sedation rate was 12.29%--more than six times the national benchmark of 2%. METHODS: The pediatric sedation team created a pediatric sedation protocol, which reflected the designation of an a2-adrenergic agonist, dexmedetomidine (dex), as the drug of choice and spearheaded a variety of performance improvement changes, including creation of a stand-alone eight-bed sedation unit to accommodate the registration process and pre-assessment and postprocedure monitoring and to include the parent in the treatment continuum. RESULTS: Following the implementation of the new protocol in 2003, the failed sedation rate for children undergoing various diagnostic and therapeutic procedures decreased from 12.29% to 1.63% in 2004, 0.19% in 2005, and 0.28% in 2006; in 2007 the rate was 0.72%--reflecting an average 98% reduction in the failed sedation rate. DISCUSSION: The continued improvement and success in pediatric sedation over time indicates that the protocol has sustained benefits and lasting value.
