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Nurse-driven intranasal dexmedetomidine administration as sedation for non-invasive procedures in children: a single centre audit

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Abstract

The purpose of this study is to audit the efficacy and safety of intranasal dexmedetomidine sedation for non-invasive procedural sedation in children provided by nurses of the procedural sedation (PROSA) team in the University Hospitals Leuven. Efficacy (successful sedation as sole sedative) and safety (cardiorespiratory monitoring, saturation) were assessed. In this audit, prospectively recorded data were extracted from the medical files in 772 patients between 4 weeks to 18 years old, who underwent sedation with intranasal dexmedetomidine (2–4 µg/kg) by the nurse-driven PROSA team, following pre-screening on risk factors. Ninety-one percent of the patients were successfully sedated (single dose, monotherapy), 60 patients (7.8%) needed an additional intervention during sedation, 37 (4.8%) needed an extra dose of intranasal dexmedetomidine, and 14 (1.8%) received an additional other sedative. Successful sedation rates were higher in younger children, and medical imaging was the most common indication. Sedation failed in 12 (1.6%) patients, with 10 of them failed to fall asleep. Adverse events were limited in number (n = 13, 1.7%) and severity: 4 patients had a low heart rate (one received atropine), one had an irregular heart rate, and 7 desaturation events were described. Hypotension was treated with normal saline in one case.

Conclusions: In this nurse-driven PROSA setting, intranasal dexmedetomidine is effective and safe for non-invasive procedural sedation in an a priori low risk group of paediatric patients.

What is Known:

• Procedural sedation outside the operating theatre or intensive care units is increasingly used, including sedation performed by non-anaesthesiologists or nurses. This resulted in the development of procedural sedation and analgesia (PROSA) teams.

• Off-label use of intranasal dexmedetomidine in children is increasing, with a limited number of audits on this practice, its safety and efficacy.

What is New:

• In an audit on 772 procedures, nurse-driven intranasal dexmedetomidine administration as sedation for non-invasive procedures in children within a structured framework was safe and effective.

• Imaging (CT, MRI) was the most common procedural indication in our study, but also nuclear imaging techniques were included.

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Availability of data and materials

The data and materials are available and can be provided by the corresponding author, if based upon reasonable request and based on a study protocol.

Abbreviations

ASA classification:

 American Society of Anesthesiologists’ classification of Physical Health

CT scan:

Computerised tomography scan

DMSA scan:

Dimercaptosuccinic acid scan

ECG:

Electrocardiogram

EC scan:

 Ethylene dicysteine scan

IV:

Intravenous

MIBG scan:

Meta-iodobenzylguanidine scan

MRI:

Magnetic resonance imaging

PAC puncture:

 Port-A-Cath puncture

PET scan:

Positron emission tomography scan ​

PO:

Per Os

PROSA:

Procedural sedation and analgesia

SD:

Standard deviation

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Author information

Author notes

  1. Emma Goyens and Karel Allegaert contributed equally as first authors.

Authors and Affiliations

  1. Faculty of Medicine, KU Leuven, Herestraat 49, 3000, Leuven, Belgium

    Emma Goyens

  2. Child and Youth Institute, KU Leuven, Herestraat 49, 3000, Leuven, Belgium

    Karel Allegaert & Jaan Toelen

  3. Department of Development and Regeneration, KU Leuven, 3000, Leuven, Belgium

    Karel Allegaert & Jaan Toelen

  4. Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, 3000, Leuven, Belgium

    Karel Allegaert

  5. Department of Hospital Pharmacy, Erasmus MC, 3000 GA, Rotterdam, the Netherlands

    Karel Allegaert

  6. Department of Anaesthesia, University Hospitals UZ, Leuven, Belgium

    Frederik De Buck & Julie Lauweryns

  7. Department of Cardiovascular Sciences, Anaesthesia and Algology, KU Leuven, Leuven, Belgium

    Frederik De Buck & Julie Lauweryns

  8. Department of Paediatrics, University Hospitals UZ Leuven, 3000, Leuven, Belgium

    Jaan Toelen & Koen Vanhonsebrouck

Authors
  1. Emma Goyens
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  2. Karel Allegaert
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  4. Julie Lauweryns
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  5. Jaan Toelen
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  6. Koen Vanhonsebrouck
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Contributions

Emma Goyens (EG), Karel Allegaert (KA), Jaan Toelen (JT) and Koen Vanhonsebrouk (KV) planned and designed the study and ensured ethics approval. KV extracted the data and created the anonymized, blinded database. EG and KA wrote the first draft. JT, KV, Frederik Debuck (FD) and Julie Lauweryns (JL) critically revised the paper. All authors (EG, KA, FD, JL, JT, KV) participated in the discussion of the results and agreed on the final version of the paper.

Corresponding author

Correspondence to Karel Allegaert.

Ethics declarations

Ethics approval and consent to participate

The study was approved by the Research Ethics Committee UZ/KU Leuven (MP016814). As audit based on a fully anonymized, blinded retrospective database analysis, consent to participate was not applicable, as supported by the Research Ethics Committee involved.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Communicated by Gregorio Milani

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Goyens, E., Allegaert, K., De Buck, F. et al. Nurse-driven intranasal dexmedetomidine administration as sedation for non-invasive procedures in children: a single centre audit. Eur J Pediatr 182, 899–905 (2023). https://doi.org/10.1007/s00431-022-04722-2

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  • DOI: https://doi.org/10.1007/s00431-022-04722-2

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