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A998
October 20, 2008
9:00 AM - 11:00 AM
Room Hall E2-Area C,
Intranasal Dexmedetomidine for Sedation during CT Scanning
Marvin S. Cohen, M.D., Amr E. Aboulleish, M.D., Martin Mueller, M.D., Deborah Elkon, M.D.
Anesthesiology, University of Texas Medical Branch, Galveston, Texas
Introduction: We report a series of twenty seven cases of sedation for CT Scans done with Dexmedetomidine administered intranasally. Dexmedetomidine is an alpha-2 adrenergic agonist that can be atomized and administered through the nasal passage in children, and is rapidly absorbed through vascular membranes in the nasal sinuses. It is well accepted as it is painless, odorless and hemodynamically stable. The result is a rapid onset of sedation (20 minutes) that preserves respiratory drive and airway reflexes.

CT scanning requires a pediatric patient to be completely still for no longer than five minutes. Most CT scans do not require intravenous administration of contrast dye. Dexmedetomidine administered intranasally obtains the desired level of deep sedation without the need for IV access.

Methods: Over 24 months 26 patients were sedated for CT scans using intranasal Dexmedetomidine. Parents were instructed to make their children NPO after 2AM for solids and formula. They were instructed to give clear liquids until 2 hours prior to their scheduled appointment. On arrival to the intake unit children greater than 9 months of age were given oral Versed (5mg/cc) 0.5mg/kg diluted in Tylenol elixir (325 mg/5cc 10mg/kg. On arrival at the CT scanner holding area they were given Intranasal Dexmedetomidine (100ug/cc) at a dose of 2ug/kg. The patients received an atomized spray of Dexmedetomidine (2 mcg/kg intranasally) administered using a tuberculin syringe attached to a Nasal Mucosal Atomizing Device (MAD® Wolfe Torry Medical Inc.) (30 micron droplets with 0.09cc dead space). After 20 minutes if the sedation was deemed inadequate the sedation was classified as failed and a second dose of IN Dexmedetomidine or IM Ketamine was administered. After the CT scan was complete the patients were monitored in the PACU until fit to return to the day surgery unit for discharge.

Results: 26 patients were between the ages of 3 months to 4 years (Median =3 ) were included in this series. One mentally challenged 14 year old was also included.[table1]Discussion: Our success rate was 80%. This technique was very well accepted by the parents as it did not require an IV to be started. Since the vital signs (SAO2 and pulse) were stable, we feel that this technique may be easily adaptable for use by properly trained non-anesthesiologists and nurse practitioners. We were initially surprised by our failure rate. However, most of the failures occurred when the drug was diluted before application. We assume a more standardized approach to preparation and delivery of the drug will increase our success rate. A drawback of this technique is the recovery time of 45 minutes which is equal to the anesthesia time. An ideal technique will allow the patient to wake up and be fully recovered within 5 to 10 minutes after the procedure is done.

References:

1. Yuen VM, Irwin MG, Hui TW, Yuen MK, Lee LH: A double-blind, crossover assessment of the sedative and analgesic effects of intranasal Dexmedetomidine. Anesth Analg 2007; 105: 374-80

2. Mason KP, et al: Dexmedetomidine for Pediatric Sedation for Computed Tomography Imaging Studies. Anesth Analg 2006; 106: 57-62.

Anesthesiology 2008; 109 A998
Results
Count (%)Wt (kgs.)Anesthesia Time (minsTime in PACUPACU Score at O mins.PACU Score at 15 minsPACU Score at 15 minsPACU Score at DC
Success22 (81%)9.7545.5245:145.15.47.7
Failed5 (19%)1148.201035.24.88