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Intranasal Dexmedetomidine Sedation for Pediatric CT Imaging

U

University of Sao Paulo

Status

Unknown

Conditions

Traumatic Brain Injury
Children

Treatments

Drug: Dexmedetomidine

Study type

Observational

Funder types

Other

Identifiers

Details and patient eligibility

About

This study has the objective to determine if intranasal dexmedetomidine, a sedative, is suitable for pediatric sedation in children undergoing tomographic scans.

Full description

Invasive procedures for diagnosis in children are a routine part of an emergency care department. Most of these procedures are painful and uncomfortable for both the child and for their families, and impossible to be performed without patient immobilization. Thus, procedural sedation is critical to this end. Procedural sedation can be defined as the use of sedatives, analgesics, or dissociative drugs for anxiolysis, analgesia, sedation and motor control during painful procedures.

The increasing demand of pediatric emergency services and, consequently, the performance of procedures that require sedation, made it impossible for universal coverage of anesthesiologists in such procedures. As a result, a wide variety of drugs, sedation techniques and different degrees of effectiveness and adverse effects of sedation, such as irritability and sedation failure are described.

Particularly in children who need CT scan, there is usually no need for venous access for sedation. However, our most used drug, chloral hydrate, was abandoned in most centers outside the country. When administered orally, the drug produces malaise and vomiting, and gastric mucosal irritation, in addition, the rectal absorption is unpredictable. Additionally, in recent years increasing importance has been given to the fact that the drug be related, in vitro, the increased carcinogenicity in mice by cellular structural change, which is leading to the ban of same drug in the United States and in some european countries.

Dexmedetomidine is a highly selective alpha-2 agonist receptors, which has the advantage of mimicking natural sleep, according to electroencephalographic studies, with low incidence of adverse events. Its application as a sedative in pediatric procedures, as well as pre-anesthetic medication, has been increasingly described according to recent studies. The intranasal route has been used with the advantage of avoiding a venous line or intramuscular injection, with good results; however, it hasn't been described yet in children undergoing CT scans.

Thus, this work is justified to describe, in a pioneering way, the use of intranasal dexmedetomidine for sedation for CT, documenting its efficacy and safety in a specific cohort of patients sedated for this purpose.

Enrollment

60 estimated patients

Sex

All

Ages

1 month to 15 years old

Volunteers

No Healthy Volunteers

Inclusion criteria

  • Children between 1 month to 15 years old undergoing CT scans in the pediatric emergency department

Exclusion criteria

  • Glasgow coma scale < 13
  • Epistaxis or suspected base skull fracture
  • Use of contrast or need for an IV line before sedation
  • Uncontrolled gastroesophageal reflux or vomiting
  • Current (or within past 3 months) history of apnea of prematurity requiring an apnea monitor
  • Acute, unstable respiratory disease
  • Unstable cardiac status
  • Craniofacial anomaly
  • Medication use: digoxin
  • Moya Moya Disease
  • New onset stroke
  • American Society of Anesthesiologists physical status ≥3

Trial design

60 participants in 1 patient group

Dexmedetomidine
Description:
All children undergoing
Treatment:
Drug: Dexmedetomidine

Trial contacts and locations

1

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Central trial contact

Eduardo Mekitarian Filho, MD, PhD

Data sourced from clinicaltrials.gov

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