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Pediatric Drugs

, Volume 17, Issue 6, pp 479–485 | Cite as

Comparison of Two Different Intranasal Doses of Dexmedetomidine in Children for Magnetic Resonance Imaging Sedation

  • Aslihan Tug
  • Ayse Hanci
  • Hacer Sebnem Turk
  • Ferda Aybey
  • Canan Tulay IsilEmail author
  • Pinar Sayin
  • Sibel Oba
Original Research Article

Abstract

Objective

Anaesthetic agents used for magnetic resonance imaging (MRI) in paediatric patients should cause few adverse effects and allow fast anaesthetic induction and recovery. The administration route is also important and should be minimally invasive. In this study, we aimed to compare two different doses of intranasal dexmedetomidine applied to children for MRI sedation.

Methods

Sixty patients between 1 and 10 years of age with American Society of Anesthesiologists Physical Status classification I or II who were scheduled for MRI were recruited into this prospective, randomized, double-blind study. Intranasal dexmedetomidine was administered at doses of 3 µg kg−1 (Group 1) and 4 µg kg−1 (Group 2) before imaging. Heart rate (HR), peripheral oxygen saturation, respiratory rate and Ramsay Sedation Scale (RSS) scores were recorded before the anaesthetic induction of sedation and every 10 min until discharge. If intranasal sedation failed, an intravenous cannula was placed and propofol was applied as a rescue anaesthetic. Bispectral Index (BIS) scores were also recorded before and after MRI. We recorded onset time of sedation, mood at separation from parents (defined as parental separation score), imaging quality, MRI duration, rescue anaesthetic requirement, total duration of sedation, recovery duration, parents’ satisfaction and adverse effects.

Results

The results related to age, weight and adverse effects were not statistically different between the groups. The parental separation score was significantly higher in Group 2 (P = 0.003). Rescue anaesthetic requirement was significantly higher in Group 1 (P = 0.002). The results related to recovery duration, MRI duration, parents’ satisfaction, onset time of sedation and total duration of sedation were not statistically different. HR was significantly lower in all time intervals compared with basal values in both groups. In Group 2, RSS scores were significantly higher in the 30th, 40th and 50th min. The BIS scores in Group 2 were lower at the 50th min. Neither bradycardia nor oxygen desaturation were observed. Imaging studies were completed successfully in all patients.

Conclusions

Based on lower rescue anaesthetic requirements, sufficient sedation and parental separation scores in Group 2, intranasal dexmedetomidine 4 µg kg−1 was more efficient than intranasal dexmedetomidine 3 µg kg−1. The intranasal route may be an alternative noninvasive route to apply drugs for MRI sedation in paediatric patients.

Trial registration ClinicalTrials.gov: NCT02299232.

Keywords

Magnetic Resonance Imaging Dexmedetomidine Magnetic Resonance Imaging Examination Ramsay Sedation Scale Recovery Duration 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

The researchers thank Orhan, a radiology technician, and Selda, a nurse, for their help during the trial.

Compliance with Ethical Standards

Funding/support

This work was funded by departmental sources.

Conflict of interest

There are no conflicts of interest to disclose.

Authors’ contributions and accountability

All authors made substantial contributions to, and take full responsibility for, the data acquisition and the integrity of the data analysis and interpretation. All authors agree to be accountable for all aspects of the work and to allow the journal editors to review their data if requested. Each author read this version of the manuscript and approved it for submission.

Ethical approval and informed consent

This study was approved by the local ethics committee of Sisli Etfal Training and Research Hospital (295//25.02.2014) and is registered at ClinicalTrials.gov (NCT02299232). Informed consent of all patients’ parents was obtained.

References

  1. 1.
    Mason KP, Zurakowski D, Zgleszewski SE, Robson CD, Carrier M, Hickey PR, et al. High dose dexmedetomidine as the sole sedative for pediatric MRI. Paediatr Anaesth. 2008;18:403–11.CrossRefPubMedGoogle Scholar
  2. 2.
    Van De Velde M, Kuypers M, Teunkens A, Devroe S. Risk and safety of anesthesia outside the operating room. Minerva Anestesiol. 2009;75(5):345–8.Google Scholar
  3. 3.
    Frankville DD, Spear RM, Dyck JB. The dose of propofol required to prevent children from moving during magnetic resonance imaging. Anesthesiology. 1993;79:953–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Bhana NL, Goa KL, McClellon KJ. Dexmedetomidine. Drugs. 2000;59:263–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Phan H, Nahata M. Clinical uses of dexmedetomidine in pediatric patients. Paediatr Drugs. 2008;10(1):49–69.CrossRefPubMedGoogle Scholar
  6. 6.
    Chrysostomou C, Schmitt CG. Dexmedetomidine: sedation, analgesia and beyond. Expert Opin Drug Metab Toxicol. 2008;4(5):619–27.CrossRefPubMedGoogle Scholar
  7. 7.
    Cimen ZS, Hanci A, Sivrikaya GU, Kilinc LT, Erol MK. Comparison of buccal and nasal dexmedetomidine premedication for pediatric patients. Paediatr Anaesth. 2013;23(2):134–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Singh H. Bispectral Index (BIS) monitoring during propofol-induced sedation and anaesthesia. Eur J Anaesthesiol. 1999;16(1):31–6.CrossRefPubMedGoogle Scholar
  9. 9.
    Koroglu A, Teksan H, Sagir O, Yucel A, Toprak HI, Ersoy OM. A comparison of the sedative, hemodynamic, and respiratory effects of dexmedetomidine and propofol in children undergoing magnetic resonance imaging. Anesth Analg. 2006;103(1):63–7.CrossRefPubMedGoogle Scholar
  10. 10.
    Ibrahim M. A prospective, randomized, double blinded comparison of intranasal dexmedetomidine vs intranasal ketamine in combination with intravenous midazolam for procedural sedation in school aged children undergoing MRI. Anesth Essays Res. 2014;8:179–86.PubMedCentralCrossRefPubMedGoogle Scholar
  11. 11.
    Iirola T, Vilo S, Manner T, Aantaa R, Lahtinen M, Scheinin M, et al. Bioavailability of dexmedetomidine after intranasal administration. Eur J Clin Pharmacol. 2011;67(8):825–31.CrossRefPubMedGoogle Scholar
  12. 12.
    Yuen VM, Irwin MG, Hui TW, Yuen MK, Lee LH. A double-blind, crossover assessment of the sedative and analgesic effects of intranasal dexmedetomidine. Anesth Analg. 2007;105(2):374–80.CrossRefPubMedGoogle Scholar
  13. 13.
    Rosen DA, Daume JT. Short duration large dose dexmedetomidine in a pediatric patient during procedural sedation. Anesth Analg. 2006;103(1):68–9.CrossRefPubMedGoogle Scholar
  14. 14.
    Gyanesh P, Haldar R, Srivastava D, Agrawal PM, Tiwari AK, Singh PK. Comparison between intranasal dexmedetomidine and intranasal ketamine as premedication for procedural sedation in children undergoing MRI: a double-blind, randomized, placebo-controlled trial. J Anesth. 2014;28(1):12–8.CrossRefPubMedGoogle Scholar
  15. 15.
    Ambi US, Joshi C, Ganeshnavar A, Adarsh E. Intranasal dexmedetomidine for paediatric sedation for diagnostic magnetic resonance imaging studies. Indian J Anaesth. 2012;56(6):587–8.PubMedCentralCrossRefPubMedGoogle Scholar
  16. 16.
    Schmidt AP, Valinetti EA, Bandeira D, Bertacchi MF, Simões CM, Auler JO Jr. Effects of preanesthetic administration of midazolam, clonidine or dexmedetomidine on postoperative pain and anxiety in children. Paediatr Anaesth. 2007;17(7):667–74.CrossRefPubMedGoogle Scholar
  17. 17.
    Petroz GC, Sikich N, James M, Van Dyk H, Shafer SL, Schily M, et al. A phase I, two-center study of the pharmacokinetics and pharmacodynamics of dexmedetomidine in children. Anesthesiology. 2006;105(6):1098–110.CrossRefPubMedGoogle Scholar
  18. 18.
    Venn RM, Bradshaw CJ, Spencer R, Brealey D, Caudwell E, Naughton C, et al. Preliminary UK experience of dexmedetomidine, a novel agent for postoperative sedation in the intensive care unit. Anaesthesia. 1999;54:1136–42.CrossRefPubMedGoogle Scholar
  19. 19.
    Munro HM, Tirotta CF, Felix DE, Lagueruela RG, Madril DR, Zahn EM, et al. Initial experience with dexmedetomidine for diagnostic and interventional cardiac catheterization in children. Paediatr Anaesth. 2007;17:109–12.CrossRefPubMedGoogle Scholar
  20. 20.
    Pandey RK, Bahetwar SK, Saksena AK, Chandra G. A comparative evaluation of drops versus atomized administration of intranasal ketamine for the procedural sedation of young uncooperative pediatric dental patients: a prospective crossover trial. J Clin Pediatr Dent. 2011;36:79–84.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • Aslihan Tug
    • 1
  • Ayse Hanci
    • 2
  • Hacer Sebnem Turk
    • 2
  • Ferda Aybey
    • 2
  • Canan Tulay Isil
    • 2
    Email author
  • Pinar Sayin
    • 2
  • Sibel Oba
    • 2
  1. 1.Algology Department, Istanbul Medical FacultyIstanbul UniversityÇapa/IstanbulTurkey
  2. 2.Anesthesiology and Reanimation DepartmentSisli Hamidiye Etfal Education and Research HospitalSisli/IstanbulTurkey

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