Dexmedetomidine is an α2 adrenoreceptor agonist that may be administered by the intranasal route as a sole sedative agent in children. It is odourless, colourless and tasteless and is formulated in a concentration of 100µg.ml−1. We performed a review of published randomised controlled trials in order to determine the efficacy of intranasal dexmedetomidine for sedation in children. Fourteen trials were eligible for inclusion in the review and contained a total of 1809 patients ranging in age from one month to 14 years. Intranasal dexmedetomidine was administered in a dose range of 1–4µg.kg−1 and was compared with various other sedatives. Dexmedetomidine was administered by either drops or a mucosal atomiser device. The procedures ranged from non-painful examinations such as magnetic resonance imaging scans and transthoracic echocardiography to painful procedures such as dentistry and venous cannulation. Administration of 2µg.kg−1 appears to be the optimal dose.
BarzegariHZohrevandiBMasoumiKForouzanADarianAAKhosraviS2015Comparison of oral midazolam and promethazine with oral midazolam alone for sedating children during computed tomographyEmergency3109–213
3.
CaoQLinYXieZShenWChenYGanXLiuY2017Comparison of sedation by intranasal dexmedetomidine and oral chloral hydrate for pediatric ophthalmic examinationPediatric Anesthesia27629–636
4.
ChernikDAGillingsDLaineH, et al1990Validity and reliability of the Observer’s Assessment of Alertness/Sedation Scale: study with intravenous midazolamJournal of Clinical Psychopharmacology10244–251
5.
ColeJWMurrayDJMcAllisterJDHirshbergGE2002Emergence behaviour in children: defining the incidence of excitement and agitation following anaesthesiaPaediatric Anaesthesia12442–447
6.
GanXLinHChenJLinZLinYChenW2016Rescue sedation with intranasal dexmedetomidine for pediatric ophthalmic examination after chloral hydrate failure: a randomized, controlled trialClinical Therapeutics381522–1529
7.
GhaiBJainKSaxenaAKBhatiaNSodhiKS2017Comparison of oral midazolam with intranasal dexmedetomidine premedication for children undergoing CT imaging: a randomized, double‐blind, and controlled studyPediatric Anesthesia2737–44
8.
HuangATanbonliongT2015Oral sedation postdischarge adverse events in pediatric dental patientsAnesthesia Progress6291–99
9.
IbrahimM2014A prospective, randomized, double blinded comparison of intranasal dexmedetomodine vs intranasal ketamine in combination with intravenous midazolam for procedural sedation in school aged children undergoing MRIAnesthesia Essays and Research8179–186
10.
JadadARMooreRACarrollD, et al1996Assessing the quality of reports of randomized clinical trials: is blinding necessary?Controlled Clinical Trials171–12
11.
Jevtovic-TodorovicVAbsalomABlomgrenK, et al2013Anaesthetic neurotoxicity and neuroplasticity: an expert group report and statement based on the BJA Salzburg SeminarBritish Journal of Anaesthesia111143–151
12.
KainZNCaldwell-AndrewsAAKrivutzaDMWeinbergMEWangSMGaalD2004Trends in the practice of parental presence during induction of anesthesia and the use of preoperative sedative premedication in the United States, 1995–2002: results of a follow-up national surveyAnesthesia and Analgesia981252–1259
13.
KainZNMayesLCBellCWeismanSHofstadterMBRimarS1997Premedication in the United States: a status reportAnesthesia and Analgesia84427–432
14.
KooEOshodiTMeschterCEbrahimnejadADongG2014Neurotoxic effects of dexmedetomidine in fetal cynomolgus monkey brainsThe Journal of Toxicological Sciences39251–262
15.
LiBLYuenVMSongXR, et al2014Intranasal dexmedetomidine following failed chloral hydrate sedation in childrenAnaesthesia69240–244
16.
LiBLZhangNHuangJX, et al2016A comparison of intranasal dexmedetomidine for sedation in children administered either by atomiser or by dropsAnaesthesia71522–528
17.
MalhotraPUThakurSSinghalP, et al2016Comparative evaluation of dexmedetomidine and midazolam-ketamine combination as sedative agents in pediatric dentistry: a double-blinded randomized controlled trialContemporary Clinical Dentistry7186–192
18.
MasonKPO’MahonyEZurakowskiDLibensonMH2009Effects of dexmedetomidine sedation on the EEG in childrenPaediatric Anaesthesia191175–1183
19.
MillerJWDingLGunterJB, et al2018Comparison of intranasal dexmedetomidine and oral pentobarbital sedation for transthoracic echocardiography in infants and toddlers: a prospective, randomized, double-blind trialAnesthesia and Analgesia1262009–2016
20.
ReynoldsJRogersAMedellinEGuzmanJAWatchaMF2016A prospective, randomized, double-blind trial of intranasal dexmedetomidine and oral chloral hydrate for sedated auditory brainstem response (ABR) testingPaediatric Anaesthesia26286–293
21.
SandersRDSunPPatelSLiMMazeMMaD2010Dexmedetomidine provides cortical neuroprotection: impact on anaesthetic-induced neuroapoptosis in the rat developing brainActa Anaesthesiologica Scandinavica54710–716
22.
ScheininMSchwinnDA1992The locus coeruleus. Site of hypnotic actions of alpha 2-adrenoceptor agonists?Anesthesiology76873–875
23.
SchlatterJKabicheSSellierNFontanJE2018Oral pentobarbital suspension for children sedation during MR imagingAnnals of Pharmacology in France76286–290
24.
ShamseerLMoherDClarkeM, et al2015Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015: elaboration and explanationBritish Medical Journal349g7647
25.
ShetaSAAlsarheedM2009Oral midazolam premedication for children undergoing general anaesthesia for dental careInternational Journal of Paediatrics 2009 274380
26.
SinnerBBeckeKEngelhardK2014General anaesthetics and the developing brain: an overviewAnaesthesia691009–1022
27.
StephenMCMathewJVargheseAMKurienMMathewGA2015A randomized controlled trial comparing intranasal midazolam and chloral hydrate for procedural sedation in childrenOtolaryngology – Head and Neck Surgery1531042–1050
28.
StewartSHBuffett-JerrottSEFinleyGAWrightKDValois GomezT2006Effects of midazolam on explicit vs implicit memory in a pediatric surgery settingPsychopharmacology188489–497
29.
SurendarMNPandeyRKSaksenaAKKumarRChandraG2014A comparative evaluation of intranasal dexmedetomidine, midazolam and ketamine for their sedative and analgesic properties: a triple blind randomized studyThe Journal of Clinical Pediatric Dentistry38255–261
30.
SuryMRArumainathanRBelhajAMMacg PalmerJHCookTMPanditJJ2015The state of UK paediatric anaesthesia: a survey of National Health Service activityPaediatric Anaesthesia251085–1092
31.
TugAHanciATurkHS, et al2015Comparison of two different intranasal doses of dexmedetomidine in children for magnetic resonance imaging sedationPaediatric Drugs17479–485
32.
XieZShenWLinJXiaoLLiaoMGanX2017Sedation effects of intranasal dexmedetomidine delivered as sprays versus drops on pediatric response to venous cannulationAmerican Journal of Emergency Medicine 35 1126–1130
33.
YuenVMHuiTWIrwinMGYaoTJWongGLYuenMK2010Optimal timing for administration of intranasal dexmedetomidine for premedication in childrenAnaesthesia65922–929
34.
YuenVMHuiTWIrwinMGYuenMK2008A comparison of intranasal dexmedetomidine and oral midazolam for premedication in pediatric anesthesia: a double-blinded randomized controlled trialAnesthesia and Analgesia1061715–1721
35.
YuenVMLiBLCheukDK, et al2017A randomised controlled trial of oral chloral hydrate vs. intranasal dexmedetomidine before computerised tomography in childrenAnaesthesia721191–1195
36.
ZhangWWangZSongXFanYTianHLiB2016Comparison of rescue techniques for failed chloral hydrate sedation for magnetic resonance imaging scans–additional chloral hydrate vs intranasal dexmedetomidinePaediatric Anaesthesia26273–279
