Intranasal dexmedetomidine premedication in children with recent upper respiratory tract infection undergoing interventional cardiac catheterisation: A randomised controlled trial
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Published on: August 28, 2021
Sen Zhang1, Ruidong Zhang, Meihua Cai
1From the Department of Anaesthesiology (SZ, RZ, MC, KZ, MZ, JZ) and Paediatric Clinical Pharmacology Laboratory, Shanghai Children's Medical Centre, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (MZ, JZ).
Insights
Intranasal dexmedetomidine (DEX) reduced peri-operative respiratory adverse events (PRAE) in young children with congenital heart disease (CHD) undergoing cardiac catheterisation. This intervention is particularly beneficial for children under three years old with recent upper respiratory tract infections (URI).
Area of Science:
- Pediatric Anesthesiology
- Cardiology
- Respiratory Medicine
Background:
- Recent upper respiratory tract infection (URI) increases peri-operative respiratory adverse events (PRAE) risk.
- Children with congenital heart disease (CHD) undergoing interventional cardiac catheterisation face heightened PRAE risk.
- Tailoring anesthetic strategies is crucial for preventing PRAE in this vulnerable pediatric population.
Purpose of the Study:
- To evaluate the efficacy of intranasal dexmedetomidine (DEX) in reducing PRAE incidence.
- To assess DEX's impact on children with recent URI undergoing interventional cardiac catheterisation.
- To specifically investigate DEX's effect in pediatric patients with CHD.
Main Methods:
- Randomized controlled trial involving 134 children (0-16 years) with CHD and recent URI.
- Participants received either intranasal DEX (1.5 μg/kg) or placebo 30-45 minutes before anesthesia induction.
- Primary outcome measure was the incidence of peri-operative respiratory adverse events (PRAE).
Main Results:
- Intranasal DEX significantly decreased PRAE incidence (P=0.001), notably oxygen desaturation (P=0.012).
- PRAE primarily occurred during the emergence phase.
- The reduction in PRAE was significant in children younger than 3 years (P=0.003) but not in older children.
Conclusions:
- Intranasal DEX (1.5 μg/kg) effectively reduces PRAE in children under 3 years with recent URI undergoing cardiac catheterisation.
- The findings support the use of intranasal DEX as a preventive measure for PRAE in this specific pediatric group.
- No significant differences were observed in emergence agitation, fever, or vomiting between groups.
Background:
Recent upper respiratory tract infection (URI) is a risk factor for the occurrence of peri-operative respiratory adverse events (PRAE). This risk may be higher in children with congenital heart disease (CHD), particularly in those undergoing interventional cardiac catheterisation. It is therefore essential to adapt the anaesthetic strategy in these children to prevent from the occurrence of PRAE.
Objective:
To determine whether intranasal dexmedetomidine (DEX) premedication can reduce the incidence of PRAE in children with recent URI undergoing interventional cardiac catheterisation.
Design:
Randomised controlled trial.
Setting:
Single-centre study based at a tertiary care centre in Shanghai, China.
Patients:
A total of 134 children with CHD aged 0 to 16 years with recent URI undergoing interventional cardiac catheterisation.
Interventions:
Children were randomised to receive either intranasal DEX 1.5 μg kg (DEX group) or intranasal saline (Placebo group) 30 to 45 min before anaesthesia induction.
Main Outcome Measures:
The incidence of PRAE.
Results:
Intranasal DEX significantly reduced the incidence of PRAE (P = 0.001), particularly oxygen desaturation (P = 0.012). Most PRAE were observed during the emergence phase. The incidence of PRAE was comparable among the three types of left-right shunt CHD children in both groups. In children aged less than 3 years, the incidence of PRAE was significantly lower in the DEX group (P = 0.003). In contrast, the incidence of PRAE was comparable between the two groups in children aged at least 3 years. No differences in the incidence of emergence agitation, fever and vomiting between the two groups were noted.
Conclusion:
Administration of intranasal DEX 1.5 μg kg 30 to 45 min before induction led to a reduction in the incidence of PRAE in children aged less than 3 years with recent URI undergoing interventional cardiac catheterisation.
Trial Registration:
chictr.org.cn identifier: ChiCTR-RRC-17012519.
