• Pediatrics · Jan 2020

    Intranasal Dexmedetomidine for Procedural Distress in Children: A Systematic Review.

    • Naveen Poonai, Joseph Spohn, Ben Vandermeer, Samina Ali, Maala Bhatt, Shawn Hendrikx, Evelyne D Trottier, Vikram Sabhaney, Amit Shah, Gary Joubert, and Lisa Hartling.
    • Department of Pediatrics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; naveen.poonai@lhsc.on.ca.
    • Pediatrics. 2020 Jan 1; 145 (1).

    ContextIntranasal dexmedetomidine (IND) is an emerging agent for procedural distress in children.ObjectiveTo explore the effectiveness of IND for procedural distress in children.Data SourcesWe performed electronic searches of Medline (1946-2019), Embase (1980-2019), Google Scholar (2019), Cumulative Index to Nursing and Allied Health Literature (1981-2019), and Cochrane Central Register.Study SelectionWe included randomized trials of IND for procedures in children.Data ExtractionMethodologic quality of evidence was evaluated by using the Cochrane Collaboration's risk of bias tool and the Grading of Recommendations Assessment, Development, and Evaluation system, respectively. The primary outcome was the proportion of participants with adequate sedation.ResultsAmong 19 trials (N = 2137), IND was superior to oral chloral hydrate (3 trials), oral midazolam (1 trial), intranasal midazolam (1 trial), and oral dexmedetomidine (1 trial). IND was equivalent to oral chloral hydrate (2 trials), intranasal midazolam (2 trials), and intranasal ketamine (3 trials). IND was inferior to oral ketamine and a combination of IND plus oral ketamine (1 trial). Higher doses of IND were superior to lower doses (4 trials). Adverse effects were reported in 67 of 727 (9.2%) participants in the IND versus 98 of 591 (16.6%) in the comparator group. There were no reports of adverse events requiring resuscitative measures.LimitationsThe adequacy of sedation was subjective, which possibly led to biased outcome reporting.ConclusionsGiven the methodologic limitations of included trials, IND is likely more effective at sedating children compared to oral chloral hydrate and oral midazolam. However, this must be weighed against the potential for adverse cardiovascular effects.Copyright © 2020 by the American Academy of Pediatrics.

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