DEX sedative is safe, effective for pediatric imaging patients

Dexmedetomidine (DEX), approved in 2008 by the FDA for use in sedation, may offer a safe, effective and efficient alternative to sedatives currently used in pediatric nuclear medicine imaging, according to a study published in the February edition of Radiology. DEX presents itself as a safer method of sedation during a time of growing demand for pediatric PET oncologic and epileptic scanning.

The study set out to determine the safety, efficacy and outcomes of bradycardia, hypotension and hypertension with DEX.  The research took place between March 2005 and August 2011 and examined the impact of DEX on 669 patients, with a mean age of 5.7 years. The pediatric patients’ most common diagnoses were seizure and malignancy, but others included brain tumor and developmental delay.

Radiologist nurses administered DEX as an intravenous bolus over a 10-minute span, followed by a continuous fusion at a rate of 1 µg/kg/h until imaging was complete. When necessary, the bolus was repeated up to two times to achieve adequate sedation.

Results showed that sufficient sedation was achieved within 8.6 minutes with a total recovery time of 41 minutes. When parents/guardians were contacted by a radiologist recovery room nurse 24 hours after the sedation, none reported adverse side effects in patients.

“With a short recovery time of 41 minutes and a predictable onset with approximately seven minutes, DEX offers benefits over other sedatives that can average recovery times of 100 minutes,”  Keira Park Mason, MD, associate professor of anesthesia at Children’s Hospital in Boston, and colleagues wrote.

Six children experienced brief periods of oxygen desaturation, but none of them required airway intervention, according to Mason et al.  Also, hypotension, hypertension and bradycardia occurred in 58.7 percent of patients, although none of these fluctuations required pharmacologic therapy.

The researchers noted that DEX offers a number of benefits over barbiturates, hypnotics and benzodiazepines. Specifically, it is the only sedative that stimulates natural non-rapid eye movement and preserves spike activity during electroencephalography (EEG). “This advantage is important because it reduces the risk that a child with intractable epilepsy will undergo hospitalization for continuous EEG monitoring and acquisition of nuclear imaging studies and be subsequently discharged without having completed the diagnostic studies simply because of the absence of a seizure after sedation with a benzodiazepine or barbiturate,” Mason and colleagues wrote.

DEX offers the advantages of predictable sedation conditions, a brief recovery period and lack of adverse events, the researchers concluded.

“DEX produces a condition similar to natural sleep, with no detrimental effect on respiration. The hemodynamic variability anticipated with DEX did not require pharmacologic treatment, and the drug was well tolerated,” the researchers wrote.