Wan Shengjun, Wu Wei, Bu Wenhao
Department of Anesthesiology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Anesthesiology, CR & WISCO General Hospital, Affiliated to Wuhan University of Science and Technology, Wuhan, China.
Medicine (Baltimore). 2024 May 3;103(18):e38040. doi: 10.1097/MD.0000000000038040.
Infants undergoing magnetic resonance imaging (MRI) often require pharmacological sedation. Dexmedetomidine serves as a novel sedative agent that induces a unique unconsciousness similar to natural sleep, and therefore has currently been used as the first choice for sedation in infants and young children.
To determine the 50% effective dose (ED50) and 95% confidence interval (95%CI) of intranasal dexmedetomidine for MRI in preterm and term infants, and to observe the incidence of adverse events. To explore whether there were differences in ED50 and 95%CI, heart rate (HR) and blood oxygen saturation (SpO2), the induction time and wake-up time and the incidence of adverse events between the 2 groups, so as to provide guidance for clinical safe medication for the meanwhile.
A total of 68 infants were prospectively recruited for MRI examination under drug sedation (1 week ≤ age ≤ 23 weeks or weight ≤ 5kg). The children were divided into 2 groups according to whether they had preterm birth experience (Preterm group, Atterm group). The Dixon up-and-down method was used to explore ED50. The basic vital signs of the 2 groups were recorded, and the heart rate and SpO2 were recorded every 5 minutes until the infants were discharged from the hospital. The induction time, wake-up time and adverse events were recorded.
The ED50 (95%CI) of intranasal dexmedetomidine in the Preterm group and the Atterm group were 2.23 (2.03-2.66) μg/kg and 2.64 (2.49-2.83) μg/kg, respectively (P < .05). the wake-up time was longer in Preterm group (98.00min) than in Atterm group (81.00 min) (P < .05), the incidence of bradycardia in Preterm group was 3/33, which was higher than that in Atterm group (1/35). There was no difference in the induction time between the 2 groups (P > .05), and there was no significant difference in other adverse events.
Intranasal dexmedetomidine can be safely used for sedation in preterm infants undergoing MRI. Compared with term infants, preterm infants have a lower dose of dexmedetomidine, a higher incidence of bradycardia, and a longer weak-up time.
接受磁共振成像（MRI）检查的婴儿通常需要药物镇静。右美托咪定是一种新型镇静剂，可诱导出类似于自然睡眠的独特无意识状态，因此目前已被用作婴幼儿镇静的首选药物。
确定经鼻给予右美托咪定用于早产和足月婴儿MRI检查的半数有效剂量（ED50）及95%置信区间（95%CI），并观察不良事件的发生率。探讨两组之间ED50及95%CI、心率（HR）和血氧饱和度（SpO2）、诱导时间和苏醒时间以及不良事件发生率是否存在差异，以便同时为临床安全用药提供指导。
前瞻性招募68例在药物镇静下接受MRI检查的婴儿（年龄1周≤年龄≤23周或体重≤5kg）。根据是否有早产经历将患儿分为2组（早产组、足月组）。采用Dixon上下法探索ED50。记录两组的基本生命体征，每5分钟记录一次心率和SpO2，直至婴儿出院。记录诱导时间、苏醒时间和不良事件。
早产组和足月组经鼻给予右美托咪定的ED50（95%CI）分别为2.23（2.03 - 2.66）μg/kg和2.64（2.49 - 2.83）μg/kg（P <.05）。早产组的苏醒时间（98.00分钟）比足月组（81.00分钟）长（P <.05），早产组心动过缓的发生率为3/33，高于足月组（1/35）。两组诱导时间差异无统计学意义（P >.05），其他不良事件差异无统计学意义。
经鼻给予右美托咪定可安全用于早产婴儿MRI检查的镇静。与足月婴儿相比，早产婴儿右美托咪定剂量较低，心动过缓发生率较高，苏醒时间较长。
