Boriosi Juan P, Eickhoff Jens C, Hollman Gregory A
Departments of Pediatrics and
Biostatistics, University of Wisconsin-Madison, Madison, Wisconsin.
Hosp Pediatr. 2019 May;9(5):348-354. doi: 10.1542/hpeds.2018-0162. Epub 2019 Apr 10.
Intranasal, intramuscular, and intravenous (IV) dexmedetomidine routes have been used successfully for pediatric MRI studies. We designed this retrospective study to determine efficacy and safety of buccal dexmedetomidine for pediatric MRI sedation.
Medical records were reviewed of outpatient children ages 5 to 18 years who received buccal dexmedetomidine with or without oral midazolam for MRI sedation at a freestanding children's hospital sedation program in 2015 and 2016.
A total of 220 outpatient encounters received buccal dexmedetomidine for MRI. Mean age of the cohort was 10.1 ± 2.6 years (range: 5-18.7). Buccal dexmedetomidine dose administered was a mean of 2.20 ± 0.38 μg/kg (range: 0.88-3.19). Of the 220 sedation encounters, 179 (81.4%) patients had satisfactory sedation with buccal dexmedetomidine with or without oral midazolam: 84 had buccal dexmedetomidine as the sole sedative, 95 had satisfactory sedation when buccal dexmedetomidine and oral midazolam (mean: 0.33 ± 0.07 mg/kg; range: 0.21-0.53) were given together, 1 (0.4%) had satisfactory sedation when intranasal fentanyl and midazolam were administered in addition to buccal dexmedetomidine, and 35 (15.9%) required IV sedatives to achieve satisfactory sedation. All patients completed their MRI successfully except 5 (2.2%): 2 encounters were sedation failures, 2 IV sedations developed severe upper airway obstruction, and 1 IV sedation experienced MRI contrast anaphylaxis.
In a selected population of pediatric patients, buccal dexmedetomidine with or without midazolam provides adequate sedation for most MRI studies with few adverse effects, but given a failure rate of almost 20%, modifications to buccal dexmedetomidine dosing should be investigated.
鼻内、肌内及静脉注射右美托咪定途径已成功用于小儿MRI检查。我们设计了这项回顾性研究，以确定口腔含服右美托咪定用于小儿MRI镇静的有效性和安全性。
回顾了2015年和2016年在一家独立儿童医院镇静项目中接受口腔含服右美托咪定联合或不联合口服咪达唑仑进行MRI镇静的5至18岁门诊患儿的病历。
共有220例门诊患儿接受口腔含服右美托咪定进行MRI检查。该队列患儿的平均年龄为10.1±2.6岁（范围：5 - 18.7岁）。口腔含服右美托咪定的给药剂量平均为2.20±0.38μg/kg（范围：0.88 - 3.19）。在这220例镇静病例中，179例（81.4%）患儿使用口腔含服右美托咪定联合或不联合口服咪达唑仑获得了满意的镇静效果：84例仅使用口腔含服右美托咪定作为唯一镇静剂，95例在同时给予口腔含服右美托咪定和口服咪达唑仑（平均：0.33±0.07mg/kg；范围：0.21 - 0.53）时获得了满意的镇静效果，1例（0.4%）在口腔含服右美托咪定的基础上还给予了鼻内芬太尼和咪达唑仑后获得了满意的镇静效果，35例（15.9%）需要静脉注射镇静剂才能获得满意的镇静效果。除5例（2.2%）外，所有患儿均成功完成了MRI检查：2例镇静失败，2例静脉注射镇静时出现严重上呼吸道梗阻，1例静脉注射镇静时发生MRI造影剂过敏反应。
在特定的小儿患者群体中，口腔含服右美托咪定联合或不联合咪达唑仑可为大多数MRI检查提供充分的镇静，且不良反应较少，但鉴于近20%的失败率，应研究调整口腔含服右美托咪定的给药剂量。
