Intranasal Dexmedetomidine for Paediatric Procedural Sedation in the Emergency Department: A Single-Centre...

To describe the use, effectiveness and safety of intranasal dexmedetomidine (IN DEX) for ED paediatric procedural sedation.

A retrospective cohort study was conducted over 7 months following implementation of an IN DEX guideline at Townsville University Hospital ED. Children aged 1-16 years were eligible if they received IN DEX. Outcomes of interest were sedation depth, ED length of stay (EDLOS), adverse events, procedural success and clinician/carer satisfaction.

A total of 114 patients were recruited. Median age was 3 years (IQR 2-5), 55.3% were male and 31.6% were Aboriginal and/or Torres Strait Islander children. Median IN DEX dose was 3.11 mcg/kg (IQR 2.81-3.93). Common indications included peripheral intravenous cannulation (35.1%), laceration repair (21.1%), burns care (13.2%), foreign body removal (11.4%) and medical imaging (8.8%). Median EDLOS was 395 min (IQR 255-579). Sedation depth was moderate (mean University Michigan Sedation Scale score 2.1 (SD 0.9), a 0-4 scale on which higher scores indicate deeper sedation; documented for 90 of 114 sedations). IN DEX was successful as a sole sedative agent in 78.1% (95% CI 69.6%-84.7%) patients, ranging from 90.0% (9/10) for medical imaging to 53.8% (7/13) for foreign body removal. Adverse events occurred in 13.2% of patients (95% CI 8.1%-20.6%), predominantly mild bradycardia. Younger age was associated with higher success rates (aOR 0.86 per year, 95% CI 0.74-0.998). No dose-response relationship was identified. Clinicians (mean 4.3/5) and parents (mean 4.5/5) reported high satisfaction, although satisfaction was documented for fewer than half of sedations and significantly more often when sedation succeeded.

In our single-centre study IN DEX is a well-tolerated, moderately effective and safe agent for ED paediatric procedural sedation with higher success rates in younger patients. Large, prospective, multisite studies are necessary to establish IN DEX's safety, effectiveness and predictors of success.