Naveen Poonai1,2,3, Joseph Spohn2, Ben Vandermeer4, Samina Ali5,6, Maala Bhatt7, Shawn Hendrikx8, Evelyne D Trottier9, Vikram Sabhaney10, Amit Shah2, Gary Joubert8,2, Lisa Hartling4. 1. Department of Pediatrics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; naveen.poonai@lhsc.on.ca. 2. Division of Emergency Medicine and. 3. Children's Health Research Institute, London Health Sciences Centre, London, Ontario, Canada. 4. Department of Pediatrics and Alberta Research Centre for Health Evidence. 5. Department of Pediatrics, Faculty of Medicine and Dentistry, and. 6. Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada. 7. Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada. 8. Department of Pediatrics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada. 9. Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montréal, Québec, Canada; and. 10. BC Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada.
Abstract
CONTEXT: Intranasal dexmedetomidine (IND) is an emerging agent for procedural distress in children. OBJECTIVE: To explore the effectiveness of IND for procedural distress in children. DATA SOURCES: We 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 SELECTION: We included randomized trials of IND for procedures in children. DATA EXTRACTION: Methodologic 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. RESULTS: Among 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. LIMITATIONS: The adequacy of sedation was subjective, which possibly led to biased outcome reporting. CONCLUSIONS: Given 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.
CONTEXT: Intranasal dexmedetomidine (IND) is an emerging agent for procedural distress in children. OBJECTIVE: To explore the effectiveness of IND for procedural distress in children. DATA SOURCES: We 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 SELECTION: We included randomized trials of IND for procedures in children. DATA EXTRACTION: Methodologic 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. RESULTS: Among 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. LIMITATIONS: The adequacy of sedation was subjective, which possibly led to biased outcome reporting. CONCLUSIONS: Given 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.
Authors: Anna Heath; Juan David Rios; Eleanor Pullenayegum; Petros Pechlivanoglou; Martin Offringa; Maryna Yaskina; Rick Watts; Shana Rimmer; Terry P Klassen; Kamary Coriolano; Naveen Poonai Journal: Trials Date: 2021-01-06 Impact factor: 2.279
Authors: Pasquale Marra; Arianna Di Stadio; Vito Colacurcio; Alfonso Scarpa; Ignazio La Mantia; Francesco Antonio Salzano; Pietro De Luca Journal: Healthcare (Basel) Date: 2022-02-01
Authors: Joji Sado-Filho; Patrícia Corrêa-Faria; Karolline A Viana; Fausto M Mendes; Keira P Mason; Luciane R Costa; Paulo S Costa Journal: J Clin Med Date: 2021-06-27 Impact factor: 4.241