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. 2017 Sep;6(3):182-187.
doi: 10.1055/s-0036-1597696. Epub 2016 Dec 26.

Comparative Effectiveness of Intranasal Dexmedetomidine-Midazolam versus Oral Chloral Hydrate Targeting Moderate Sedation during Pediatric Transthoracic Echocardiograms

Jordan Fett  1 , Richard Hackbarth  1   2 , Brian M Boville  1   2 , Anthony D Olivero  1   2 , Alan T Davis  3 , John W Winters  1   2
Affiliations

Comparative Effectiveness of Intranasal Dexmedetomidine-Midazolam versus Oral Chloral Hydrate Targeting Moderate Sedation during Pediatric Transthoracic Echocardiograms

Jordan Fett et al. J Pediatr Intensive Care. 2017 Sep.

Abstract

Objective To compare efficacy and safety of two moderate sedation regimens for transthoracic echocardiography (TTE): intranasal dexmedetomidine-midazolam (DM) versus oral chloral hydrate (CH) syrup. Method This was a retrospective cohort of 93 children under 4 years of age receiving moderate sedation with either DM or CH for TTE from January 2011 through December 2014. Measurements and Main Results Forty-nine patients received oral CH and 44 received the intranasal combination of DM. The demographics between groups were similar except the DM patients were slightly older and heavier (each p < 0.05). Failure rate between groups did not reach statistical significance (CH 14.3% vs. DM 6.8%; p = 0.324). Total sedation to discharge time was similar between groups (CH 89.4 minutes vs. DM 89.6 minute; p = 0.97). Cardiopulmonary data did reveal a significantly lower heart rate (101.9 vs. 91.7; p < 0.001) and respiratory rate (23.4 vs. 21.0, p = 0.03) in the DM group, but no difference in blood pressure measurements or echo determined shortening fraction. Conclusion These data support the use of intranasal DM as a safe and efficacious method of moderate sedation for children undergoing TTE.

Keywords: chloral hydrate; intranasal dexmedetomidine–midazolam; transthoracic echocardiography.

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Conflict of interest statement

Conflict of Interest None. Funding None. Ethics Approval This study was approved by the Institutional Review Board of Helen DeVos Children's Hospital.

References

    1. Malviya S, Voepel-Lewis T, Tait A R, Merkel S, Tremper K, Naughton N. Depth of sedation in children undergoing computed tomography: validity and reliability of the University of Michigan Sedation Scale (UMSS) Br J Anaesth. 2002;88(02):241–245. - PubMed
    1. Wolfe T R, Braude D A. Intranasal medication delivery for children: a brief review and update. Pediatrics. 2010;126(03):532–537. - PubMed
    1. Miller J L, Ashford J W, Archer S M, Rudy A C, Wermeling D P. Comparison of intranasal administration of haloperidol with intravenous and intramuscular administration: a pilot pharmacokinetic study. Pharmacotherapy. 2008;28(07):875–882. - PubMed
    1. Wermeling D P, Miller J L, Archer S M, Manaligod J M, Rudy A C. Bioavailability and pharmacokinetics of lorazepam after intranasal, intravenous, and intramuscular administration. J Clin Pharmacol. 2001;41(11):1225–1231. - PubMed
    1. Veldhorst-Janssen N M, Fiddelers A A, van der Kuy P H, Neef C, Marcus M A. A review of the clinical pharmacokinetics of opioids, benzodiazepines, and antimigraine drugs delivered intranasally. Clin Ther. 2009;31(12):2954–2987. - PubMed