Rescue Sedation With Intranasal Dexmedetomidine for Pediatric Ophthalmic Examination After Chloral Hydrate Failure: A Randomized, Controlled Trial

• Published in: Clinical therapeutics 2016-06, Vol.38 (6), p.1522-1529
• Main Authors: Gan, Xiaoliang, MD, PhD, Lin, Haotian, MD, PhD, Chen, Jingjing, MD, Lin, Zhuoling, MD, Lin, Yiquan, MD, Chen, Weirong, MD
• Format: Article
• Language: English
• Subjects: Administration, Intranasal; Airway management; Anesthesia; Body Weight; Cataract - diagnosis; Cataract - diagnostic imaging; Cataracts; Child, Preschool; Chloral Hydrate; Conflicts of interest; Conscious Sedation; Dexmedetomidine; Diagnostic tests; Drug dosages; Female; Humans; Hypnotics and Sedatives; Infant; Internal Medicine; Male; Medical Education; Medical personnel; ophthalmic; pediatric; Pediatrics; Prospective Studies; sedation; Tomography, X-Ray Computed
• ISSN: 0149-2918; 1879-114X
• DOI: 10.1016/j.clinthera.2016.04.036

Abstract Purpose It is a challenge to rescue ophthalmology examinations performed in children in the sedation room after initial chloral hydrate failure. Intranasal dexmedetomidine can be used in rescue sedation in children undergoing computed tomography. The present study aimed to assess the efficacy and tolerability of intranasal dexmedetomidine use in children undergoing ophthalmic examination after chloral hydrate failure. Methods Sixty uncooperative pediatric patients with cataract (aged 5–36 months; weight, 7–15 kg) presented for follow-up ophthalmic examination. Patients who experienced chloral hydrate failure were randomized to 1 of 2 groups to receive intranasal dexmedetomidine 1 or 2 μg/kg for rescue sedation. Each group contained 30 patients. The primary outcome was the rate of a successful ophthalmic examination. Secondary outcomes included sedation onset time, recovery time, duration of examination, discharge time, and adverse events, including percentage of heart rate reduction, respiratory depression, vomiting, and postsedative agitation. Findings A successful ophthalmic examination was achieved in 93.3% (28/30) of patients in the 2-μg/kg dose group and in 66.7% (20/30) of patients in the 1-μg/kg dose group ( P = 0.021). The onset time, recovery time, and discharge time did not significantly differ between the 2 groups. None of the patients required clinical intervention due to heart rate reduction, and none of the patients in either group experienced vomiting, respiratory depression, or agitation after the administration of dexmedetomidine. Implications In children undergoing ophthalmic examination, intranasal dexmedetomidine can be administered in the sedation room for rescue sedation after chloral hydrate failure, with the 2-μg/kg dose being more efficacious than the 1-μg/kg dose, as measured by success rate. ClinicalTrials.gov identifier: NCT02077712.