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Effect of nebulized dexmedetomidine on gag reflex suppression and sedation quality in pediatric patients undergoing

Esra Turunc1, Yasemin Burcu Ustun2, Sezgin Bilgin2

  • 1Department of Anesthesiology and Reanimation, Faculty of Medicine, Ondokuz Mayis University, Kurupelit, Samsun, TR55139, Turkey. esra.kiymaz.ek@gmail.com.

BMC Anesthesiology
|May 3, 2025
PubMed

Insights

Nebulized dexmedetomidine significantly reduces gag and cough reflexes in pediatric endoscopy patients. This safe and effective premedication improves patient comfort and procedural success.

Area of Science:

  • Pediatric Gastroenterology
  • Anesthesiology
  • Pharmacology

Background:

  • Pediatric upper gastrointestinal (GI) endoscopy often necessitates sedation and analgesia.
  • The gag reflex presents a significant challenge during endoscopic probe placement in children.
  • Effective management of gag reflex is crucial for successful pediatric GI procedures.

Purpose of the Study:

  • To investigate the efficacy of nebulized dexmedetomidine as a premedication in pediatric patients undergoing upper GI endoscopy.
  • To assess the impact of nebulized dexmedetomidine on gag reflex severity during pediatric endoscopy.
  • To evaluate secondary outcomes including cough, anxiety, agitation, and endoscopist satisfaction.

Main Methods:

  • A single-center, prospective, randomized controlled trial was conducted involving pediatric patients aged 2-17 years.
  • Participants were randomized to receive either nebulized dexmedetomidine (2 µg/kg) or no premedication.
  • Gag reflex severity was the primary outcome; cough, anxiety, agitation, and satisfaction were secondary outcomes.

Main Results:

  • Nebulized dexmedetomidine significantly reduced gag reflex incidence (88.3% vs. 30%, p<0.001) and coughing (95% vs. 55%, p<0.001).
  • The dexmedetomidine group showed significantly lower separation anxiety scores (p<0.005).
  • Reduced need for additional anesthetics and higher endoscopist satisfaction were observed, with no significant increase in complications.

Conclusions:

  • Nebulized dexmedetomidine is a safe and effective premedication for pediatric endoscopy.
  • It significantly mitigates gag and cough reflexes, enhancing patient comfort and procedural safety.
  • This approach improves endoscopist satisfaction and reduces anesthetic requirements in pediatric GI procedures.
Abstract

Keywords:
EndoscopyGag reflexNebulized dexmedetomidinePediatric anesthesiaSedation

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