Perioperative Medicine  |   December 2016
Median Effective Dose of Intranasal Dexmedetomidine for Rescue Sedation in Pediatric Patients Undergoing Magnetic Resonance Imaging
Author Notes
  • From the Department of Anesthesiology, Guangzhou Women and Children’s Medical Center, Guangzhou, China.
  • Submitted for publication April 7, 2016. Accepted for publication July 6, 2016.
    Submitted for publication April 7, 2016. Accepted for publication July 6, 2016.×
  • Address correspondence to Dr. Song: Department of Anesthesiology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, No. 9 Jinsui Road, Zhujiang New Town, Tianhe District, Guangzhou, China. songxr1966@126.com. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Clinical Science / Pediatric Anesthesia / Pharmacology / Radiological and Other Imaging
Perioperative Medicine   |   December 2016
Median Effective Dose of Intranasal Dexmedetomidine for Rescue Sedation in Pediatric Patients Undergoing Magnetic Resonance Imaging
Anesthesiology 12 2016, Vol.125, 1130-1135. doi:10.1097/ALN.0000000000001353
Anesthesiology 12 2016, Vol.125, 1130-1135. doi:10.1097/ALN.0000000000001353
Abstract

Background: The median effective dose (ED50) of intranasal dexmedetomidine after failed chloral hydrate sedation has not been described for children. This study aims to determine the ED50 of intranasal dexmedetomidine for rescue sedation in children aged 1 to 36 months, who were inadequately sedated by chloral hydrate administration during magnetic resonance imaging (MRI).

Methods: This study was performed on 120 children, who were 1 to 36 months old and underwent MRI scanning. Intranasal dexmedetomidine was administered as a rescue sedative to children not adequately sedated after the initial oral dose of chloral hydrate (50 mg/kg). Children were stratified into four age groups. ED50 values were estimated from the up-and-down method of Dixon and Massey and probit regression. Other variables included induction time, time to wake up, vital signs, oxygen saturation, MRI scanning time, and recovery characteristics.

Results: ED50 of intranasal dexmedetomidine for rescue sedation was 0.4 μg/kg (95% CI, 0.34 to 0.50) in children aged 1 to 6 months, 0.5 μg/kg (95% CI, 0.48 to 0.56) in children aged 7 to 12 months, 0.9 μg/kg (95% CI, 0.83 to 0.89) in children aged 13 to 24 months, and 1.0 μg/kg (95% CI, 0.94 to 1.07) in children aged 25 to 36 months. There were no significant differences in sedation induction time or time to wake up between the different age groups. Additionally, no significant adverse hemodynamic or hypoxemic effects were noted.

Conclusions: The authors determined the ED50 for rescue sedation using intranasal dexmedetomidine after failed chloral hydrate sedation in children. It was found that ED50 increases with advancing age during the first 3 yr of life.