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Clinical Trial
. 2025 Oct 24:19:9523-9532.
doi: 10.2147/DDDT.S544737. eCollection 2025.

Intranasal Dexmedetomidine with Propofol Provides Superior Sedation for Pediatric Contrast-Enhanced CT: A Randomized Controlled Trial

Su-Jing Zhang #  1   2   3 , Yan-Jun Weng #  1 , Qian Lei  1 , Min-Yi Lin  1 , Hua-Lin Chen #  1   4 , Tuan-Fang Fang #  1   3 , Guo-Lin Lu #  1   3
Affiliations
Clinical Trial

Intranasal Dexmedetomidine with Propofol Provides Superior Sedation for Pediatric Contrast-Enhanced CT: A Randomized Controlled Trial

Su-Jing Zhang et al. Drug Des Devel Ther. .

Abstract

Background: Effective and safe sedation with rapid recovery remains a critical unmet need for pediatric patients undergoing contrast-enhanced computed tomography (contrast-enhanced CT). We compared the efficacy of intranasal dexmedetomidine (DEX) combined with intravenous propofol (D-P) versus DEX with buccal midazolam (D-M) for sedation during pediatric contrast-enhanced CT.

Methods: In this single-center, prospective, randomized controlled trial, 110 children (6 months-6 years, ASA I/II) were allocated to D-M (2 μg/kg intranasal DEX + 0.2 mg/kg buccal midazolam) or D-P (2 μg/kg intranasal DEX + 1 mg/kg intravenous propofol). Primary outcome was one-time success rate (completed contrast-enhanced CT without additional sedation). Secondary outcomes included onset time, recovery metrics (Ramsay Sedation Scale [RSS] at 30 minutes, time to oral intake), and adverse events. Analyses followed full-analysis-set (FAS) and per-protocol-set (PPS) principles (ChiCTR2300067469).

Results: The D-P group demonstrated superior one-time success rates in both FAS (96.4% vs 74.5%; OR 9.05, 95% CI 1.95-42.05, P =0.001) and PPS analyses (96.4% vs 77.1%; OR 7.88, 95% CI 1.65-37.6, P =0.003). Sedation onset was faster with D-P (median 17 vs 20 minutes, P < 0.001), with 98.2% achieving sleep within 20 minutes versus 54.5% for D-M. Recovery was accelerated in D-P: 61.8% attained RSS ≤3 by 30 minutes (vs 30.9%, P < 0.001), and 77.3% resumed oral intake within 1 hour (vs 25.4%, P < 0.001). Bradycardia occurred more frequently with D-P (29.1% vs 5.4%, P =0.001), but no interventions were required.

Conclusion: Intranasal dexmedetomidine combined with propofol significantly improves sedation success, accelerates recovery, and reduces procedural delays in pediatric contrast-enhanced CT compared to midazolam, offering a clinically advantageous regimen for short-duration imaging.

Keywords: computed tomography; dexmedetomidine; midazolam; pediatrics; propofol; sedation.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Consort flow diagram.
Figure 2
Figure 2
Onset time of sedation in D-P group and D-M group.
Figure 3
Figure 3
Time resumes to intake in D-P group and D-M group.
See this image and copyright information in PMC

References

    1. Ragel M, Nedumaran A, Makowska-Webb J. Prospective comparison of use of contrast-enhanced ultrasound and contrast-enhanced computed tomography in the Bosniak classification of complex renal cysts. Ultrasound. 2016;24(1):6–16. doi: 10.1177/1742271X15626959 - DOI - PMC - PubMed
    1. Masui T, Katayama M, Kobayashi S, Sakahara H. Intravenous injection of high and medium concentrations of computed tomography contrast media and related heat sensation, local pain, and adverse reactions. J Comput Assist Tomogr. 2005;29(5):704–708. doi: 10.1097/01.rct.0000171238.10678.54 - DOI - PubMed
    1. Kim JY, Kim KN, Kim DW, Lim HJ, Lee BS. Effects of dexmedetomidine sedation for magnetic resonance imaging in children: a systematic review and meta-analysis. J Anesth. 2021;35(4):525–535. doi: 10.1007/s00540-021-02946-4 - DOI - PubMed
    1. Siddappa R, Riggins J, Kariyanna S, Calkins P, Rotta AT. High‐dose dexmedetomidine sedation for pediatric MRI. Paediatr Anaesth. 2011;21(2):153–158. doi: 10.1111/j.1460-9592.2010.03502.x - DOI - PubMed
    1. Gu HB, Miao LY, Bai J, Lu GL, Lei Q, Yang LJ, Wang DG. Combined use of intranasal Dexmedetomidine and an oral novel formulation of Midazolam for sedation of young children during brain MRI examination: a prospective, single-center, randomized controlled trial. BMC Anesthesiol. 2022;22(1):357. doi: 10.1186/s12871-022-01897-x - DOI - PMC - PubMed

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