Intranasal dexmedetomidine for procedural sedation in infants: a retrospective study

Infants undergoing magnetic resonance imaging (MRI) often require pharmacological sedation. Dexmedetomidine is an alpha-2 receptor agonist that is frequently used to sedate children and infants, because the neonatologist can easily adjust sedation depth, the patient maintains spontaneous breathing, and awakens rapidly afterwards. The present study evaluates whether dexmedetomidine could safely be used as the sole sedative for preterm and term-born infants less than 80 weeks' postmenstrual age undergoing diagnostic procedures.

We performed a retrospective monocentric analysis of 50 preterm and term-born infants (<80 weeks' postmenstrual age) who were sedated with dexmedetomidine for a brain MRI from October 2019 to March 2024.

Successful imaging was achieved in all cases. The median dexmedetomidine loading dose was 2.75 μg/kg (2-4 μg/kg). Bradycardia was observed in four out of 50 patients (8%) and none of them required atropine.

These results suggest that dexmedetomidine can be safely used for procedural sedation in the high-risk cohort of preterm and term-born infants less than 80 weeks' postmenstrual age.