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• Inferior outcomes with chloral hydrate and by an awareness of its impending discontinuation by the manufacturer.v. placement. allow rapid patient recovery. produce sufficient level of sedation for study completion. • The ideal sedative would have a rapid onset . . BACKGROUND • No clear standard of care for sedation of children for non- painful studies or procedures • Non-painful procedures that do not otherwise require i. access. the agent would ideally be administered without needing to inflict pain by securing i.v. favourable side effect profile. and have low cost.

Objective • This study examines the effectiveness and safety of IN dexmedetomidine for sedation of patients undergoing electroencephalogram (EEG) and auditory brain response (ABR) testing. • The intranasal (IN) route avoids the pain of intravenous (i. .) catheter placement but limited literature exists on the use of IN dexmedetomidine. anxiolytic. and analgesic properties.v. • Dexmedetomidine is an a2 agonist with sedative.

v. The drug dose was divided into two equal aliquots. began using IN dexmedetomidine for non-painful studies.5–3 mcg/kg IN dexmedetomidine was given with a repeat dose of 1–1. • All patients requiring sedation for an outpatient EEG or ABR between October 1. • The dexmedetomidine formulation used is the 100 mcg/ml solution which is used for i.5 mcg/kg IN if needed 30 min later. injection. a county hospital in San Jose. ASA I & II. CA. • An initial dose of 2. 2012 and October 1. 2014 were included in this study. with one aliquot administered into each nostril by the nurse using an atomizer device . METHODS • The pediatric sedation team at Santa Clara Valley Medical Centre.

recorded every 5 min. • Additional data (including vital sign parameters) were gathered from retrospective chart reviews . • Nurses recorded the level of consciousness (ranging from ‘alert’ to ‘lethargic’ to ‘sedated but arousable to verbal stimuli’ to ‘sedated but arousable to painful stimuli’) every 5 min once sedation was attained • Pre.and post-procedure Aldrette scores. • Patient information was extracted from quality assurance database.EtCO2 (if applicable). which included prospectively entered information such as demographics. drug dosing.SpO2. timing.ECG.• NIBP. and a detailed description of adverse events. study type.

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as ascertained from the parents by the sedation nurse and number of daily medications. and need for escalation of respiratory support. and medical complexity. • Hypotension and bradycardia were defined as a > 20% deviation from age-adjusted awake normal values . hypoxemia. . • The database included two data points as measures of degree of chronic illness or medical complexity: a reported history of behavioral problems or developmental delay. bradycardia.• Demographic data collected included: age. gender. • Adverse outcomes measured included:hypotension. weight.

USA). • The study was approved by the Institutional Review Board at Santa Clara Valley Medical Center. • Informed consent was not required. . Texas.• Descriptive statistics were generated using STATA v.13 (StataCorp.College Station.

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RESULTS…… .

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• Five patients (all infants) awoke prior to the end of the study but all were able to complete it after being fed . • Median duration of sedation =107 min for ( 90–131 min). RESULTS • Median time of sedation onset = 25 min (20– 32 min).

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.7%) with hypotension which resolved without intervention • 6 patients with oxygen desaturation <90% • (two of whom received supplemental oxygen. and one patient with an underlying upper airway abnormality who was treated with continuous positive airway pressure). Adverse events • 18 patients (10.

Conclusions • IN dexmedetomidine is an effective and non- invasive method of sedating children for EEG and ABR. .

Pros • Safe • The overall effectiveness of dexmedetomidine can be further enhanced by repeat dosing. • No respiratory depression/No N.V • No interaction with epileptiform waves • avoids i.v. placement or IM injection • ECHO/CT/COC .

dosing. Cons • No randomisation/control group • off-label • Few studies of IN dexmedetomidine for pediatric sedation outside of pre-surgical anxiolysis • further data are needed regarding effectiveness. time to onset of sedation. recovery time. and incidence and frequency of adverse events • MRI (2/8) .

• Onset of sedation time with 2nd dose • No reversal agent .

Opinions ? .