In this episode, I’ll discuss an article about intranasal dexmedetomidine for procedural sedation in the ED.
Dexmedetomidine continues to emerge as a potential sedative agent for procedural sedation in areas like the Emergency Department. Some advantages of dexmedetomidine include a lack of effect on respiratory drive, adjunctive effects on analgesia, and multiple routes of administration. The major adverse effects are hypotension and bradycardia although these often do not require treatment or resolve with minimal intervention.
A group of authors recently published a 4-arm dose finding study using intranasal dexmedetomidine in pediatric ED patients requiring closure of a single laceration.
Patients were aged zero to 10 years and were administered 1, 2, 3, or 4 mcg/kg of dexmedetomidine using the intranasal route.
There were 3 patients in the 1mcg/kg group, 9 patients in the 2 mcg/kg group, and 21 patients each in the 3 and 4 mcg/kg groups.
The primary outcome of the study was the proportion of patients with adequate sedation as judged by a Pediatric Sedation State Scale score of 2 or 3 for at least 90% of the time from sterile preparation to the tying of the last suture.
Secondary outcomes included measures of patient distress, postprocedure length of stay, and adverse events.
The 1 and 2 mcg/kg groups performed the worst, with only 33% and 22% of patients adequately sedated, respectively. The 3 and 4 mcg/kg groups had 62% and 57% of patients adequately sedated, respectively and analysis based on equitailed credible intervals suggested either dose could be considered optimal.
There were no meaningful differences in length of stay and signs of distress in the 3 and 4 mcg/kg groups. There was only 1 adverse event in the entire study – a patient who received 4 mcg/kg experienced a decrease in oxygen saturation which resolved after head repositioning.
Pharmacists that care for patients in areas where procedural sedation is performed should be aware that dexmedetomidine may have a potential role as a sedative in both pediatric and adult patients and that in addition to the IV route, intranasal, subcutaneous, or oral administration of dexmedetomidine have various degrees of published evidence supporting use for sedation.
Members of my Hospital Pharmacy Academy have access to practical training from a pharmacist’s point of view on using dexmedetomidine in critical care. This is in addition to many other resources to help in your practice. The Hospital Pharmacy Academy is my online membership site that teaches pharmacists practical critical care and hospital pharmacy skills you can apply at the bedside so that you can become confident in your ability to save lives and improve patient outcomes. To get immediate access, go to pharmacyjoe.com/academy.
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