Intranasal Dexmedetomidine With Intravenous Midazolam: A Safe and Effective Alternative in the Paediatric MRI Sedation.
intranasal dexmedetomidine
intravenous midazolam
mri
nonoperating room anaesthesia (nora)
paediatric
Journal
Cureus
ISSN: 2168-8184
Titre abrégé: Cureus
Pays: United States
ID NLM: 101596737
Informations de publication
Date de publication:
Oct 2023
Oct 2023
Historique:
accepted:
03
10
2023
medline:
13
11
2023
pubmed:
13
11
2023
entrez:
13
11
2023
Statut:
epublish
Résumé
Background and aims MRI sedation in paediatrics includes challenges like respiratory depression, maintaining haemodynamic stability and use of neuroprotective drugs, since MRI is performed in remote places outside the operating room with a lack of support staff and nonavailability of choice of medications and equipments. The primary aim was to use a combination of the drugs to encounter the above challenges and look for its efficacy. The secondary aim of the study was to determine the rate of successful completion of MRI in children using a combination of intranasal dexmedetomidine and intravenous midazolam - without the need for rescue sedatives. Methods This is an observational study involving 60 children in the age group between two months and six years undergoing an MRI. Children belonging to the American Society of Anesthesiology (ASA) 1 and 2 were given intranasal dexmedetomidine 3µg/kg, time to onset of sedation was noted and injection of midazolam 0.1 mg/kg was given intravenously. MRI was started once the child was asleep. Children who woke up during the MRI were supplemented with inj. propofol 0.5-1mg/kg and were documented. Results The median time duration for MRI was 38.7 min and the onset of sedation after intranasal dexmedetomidine was 18.7 min. The scan was successfully completed with a combination of intranasal dexmedetomidine and intravenous midazolam in 86.7% and only 13.3% of the children woke up either at the start or in between the scan and required the addition of propofol. Conclusion Drugs used for sedation during MRI should not cause respiratory depression and be safe for the developing brain. The above study has shown that a combination of intranasal dexmedetomidine and intravenous midazolam is effective and safe in performing MRIs in paediatrics.
Identifiants
pubmed: 37954765
doi: 10.7759/cureus.46787
pmc: PMC10634237
doi:
Types de publication
Journal Article
Langues
eng
Pagination
e46787Informations de copyright
Copyright © 2023, KG et al.
Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
Ann Emerg Med. 2009 Aug;54(2):171-80.e1-4
pubmed: 19501426
Paediatr Drugs. 2008;10(1):49-69
pubmed: 18162008
Int J Clin Pharmacol Ther. 2014 Sep;52(9):756-61
pubmed: 24887336
Hosp Pediatr. 2018 Jan 23;:
pubmed: 29363517
Expert Opin Drug Saf. 2011 Jan;10(1):55-66
pubmed: 20718689
Eur J Clin Pharmacol. 1992;42(3):329-32
pubmed: 1577053
Acta Anaesthesiol Scand. 2010 Jul;54(6):710-6
pubmed: 20003127
Curr Opin Anaesthesiol. 2008 Aug;21(4):457-61
pubmed: 18660652
Pediatr Emerg Care. 2020 Mar;36(3):138-142
pubmed: 28609332
Paediatr Anaesth. 2016 Mar;26(3):280-5
pubmed: 26814037
J Pediatr. 2015 May;166(5):1313-1315.e1
pubmed: 25748567
Ann Emerg Med. 2003 Dec;42(6):792-7
pubmed: 14634604
Anesth Analg. 2020 Apr;130(4):949-957
pubmed: 31206433
J Pediatr Intensive Care. 2017 Jun;6(2):117-122
pubmed: 31073434
Clin Pharmacol Ther. 1994 Dec;56(6 Pt 1):615-25
pubmed: 7995003
Neurotoxicol Teratol. 2011 Mar-Apr;33(2):220-30
pubmed: 21241795
Clin Pharmacokinet. 1996 Dec;31(6):423-43
pubmed: 8968656
Anesth Analg. 2006 Jul;103(1):63-7, table of contents
pubmed: 16790627
Anesth Analg. 2009 Sep;109(3):745-53
pubmed: 19690241
Anesthesiology. 1993 May;78(5):885-91
pubmed: 8489062
Paediatr Anaesth. 2017 Sep;27(9):976-977
pubmed: 28772009
Anaesthesia. 2010 Sep;65(9):922-9
pubmed: 20645951
Indian J Anaesth. 2019 Sep;63(9):754-762
pubmed: 31571689
J Neurosurg Anesthesiol. 2016 Apr;28(2):123-40
pubmed: 26465642
Int J Pediatr. 2010;2010:701257
pubmed: 20981309
Ann Emerg Med. 2008 Apr;51(4):378-99, 399.e1-57
pubmed: 18359378