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Intranasal Dexmedetomidine for Procedural Distress in Children: A Systematic Review

Naveen Poonai1,2,3, Joseph Spohn2, Ben Vandermeer4

  • 1Department of Pediatrics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; naveen.poonai@lhsc.on.ca.

Pediatrics
|December 22, 2019
PubMed

Insights

Intranasal dexmedetomidine (IND) effectively sedates children during procedures, outperforming oral chloral hydrate and midazolam. While generally safe, potential cardiovascular side effects require consideration.

Area of Science:

  • Pediatric Anesthesiology
  • Pharmacology
  • Evidence-Based Medicine

Background:

  • Intranasal dexmedetomidine (IND) is an emerging agent for managing procedural distress in pediatric patients.
  • Effective procedural sedation is crucial for improving patient comfort and cooperation during medical interventions.

Purpose of the Study:

  • To systematically evaluate the efficacy and safety of intranasal dexmedetomidine (IND) for procedural sedation in children.
  • To compare IND with other sedative agents commonly used in pediatric practice.

Main Methods:

  • A comprehensive literature search was conducted across multiple databases (Medline, Embase, CINAHL, Cochrane) up to 2019.
  • Included were 19 randomized controlled trials involving 2137 children, assessing the primary outcome of adequate sedation.
  • Methodologic quality was assessed using the Cochrane risk of bias tool and GRADE system.

Main Results:

  • Intranasal dexmedetomidine (IND) demonstrated superiority over oral chloral hydrate and oral midazolam in several trials.
  • IND showed comparable effectiveness to oral chloral hydrate, intranasal midazolam, and intranasal ketamine.
  • Adverse events were less frequent with IND (9.2%) compared to comparator groups (16.6%), with no serious events reported.

Conclusions:

  • Intranasal dexmedetomidine (IND) appears more effective for sedating children than oral chloral hydrate and oral midazolam, based on current evidence.
  • Potential cardiovascular adverse effects should be considered when using IND.
  • Further high-quality trials are needed to confirm efficacy and safety due to methodologic limitations.
Abstract

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