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A Comparison of Intranasal Dexmedetomidine and Dexmedetomidine Plus Buccal Midazolam for Non-painful Procedural Sedation in Children with Autism

Journal of Autism and Developmental Disorders volume 49, pages 3798–3806 (2019)Cite this article

Abstract

Children with autism often need sedation for diagnostic procedures and they are often difficult to sedate. This prospective randomized double-blind control trial evaluates the efficacy and safety using intranasal dexmedetomidine with and without buccal midazolam for sedation in children with autism undergoing computerized tomography and/or auditory brainstem response test. The primary outcome is the proportion of children attaining satisfactory sedation. One hundred and thirty-six children received intranasal dexmedetomidine and 139 received intranasal dexmedetomidine with buccal midazolam for sedation. Combination of intranasal dexmedetomidine and buccal midazolam was associated with higher sedation success when compared to intranasal dexmedetomidine. Since intranasal and buccal sedatives required little cooperation this could be especially useful technique for children with autism or other behavioral conditions.

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Acknowledgments

We gratefully acknowledge the assistance of Ms Jeff SF Man, Department of Anaesthesiology, University of Hong Kong, for statistical analysis. BLL and VMY conceived of the study, participated in its design, coordination, interpretation of the data and drafted and revised the manuscript. BLL, NZ, HHZ, JXH, SYY helped gathering data, conceptualizing and drafting the initial manuscript, and approved the final manuscript as submitted. JMM and XRS participated in the design and carried out the initial analyses, reviewed and revised the manuscript, and approved the final manuscript as submitted. All authors critically reviewed and approved the final manuscript as submitted.

Funding

This study is funded by Guangzhou Health and Family Planning Commission Program (No. 20182A011005), Guangzhou, China and Guangzhou Women and Children’s Medical Center/Guangzhou Institute of Pediatrics (No. Pre-NSFC- 2018-015), Guangzhou, China.

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    Affiliations

    1. Department of Anaesthesiology, Guangzhou Women and Children’s Medical Centre, Guangzhou Medical University, 9 Jinsui Road, Guangzhou, 510623, Guangdong, China

      Bi Lian Li, Na Zhang, Huan Huan Zhang, Jun Xiang Huang & Xing Rong Song

    2. Department of Anaesthesiology and Perioperative Medicine, Hong Kong Children’s Hospital, Hong Kong, China

      Vivian Man-ying Yuen

    3. Department of Psychiatry, Guangzhou Women and Children’s Medical Centre and Guangzhou Medical University, Guangzhou, China

      Si Yuan Yang

    4. Department of Anaesthesiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

      Jeffery W. Miller

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    1. Bi Lian Li
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    Bi Lian Li and Vivian Man-ying Yuen contributed equally to this study.

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    Li, B.L., Yuen, V.My., Zhang, N. et al. A Comparison of Intranasal Dexmedetomidine and Dexmedetomidine Plus Buccal Midazolam for Non-painful Procedural Sedation in Children with Autism. J Autism Dev Disord 49, 3798–3806 (2019). https://doi.org/10.1007/s10803-019-04095-w

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    Keywords

    • Autism
    • Dexmedetomidine
    • Midazolam
    • Pediatric sedation