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Predictors of pediatric sedation failure with initial dose of intranasal dexmedetomidine and oral midazolam

Pediatric Research volume 94, pages 2054–2061 (2023)Cite this article

Abstract

Background

To assess the sedative failure rate over different dose combinations of intranasal dexmedetomidine and oral midazolam for procedural sedation.

Methods

This was a retrospective study. Four groups were established according to the initial dose of sedatives. The primary outcome was the sedative failure rate for different doses of the two-drug combination. The risk factors associated with sedation failure were analyzed.

Results

A total of 2165 patients were included in the final analysis. Of these, 394 children were classified as sedation failure after the initial dose of a combination of intranasal dexmedetomidine and oral midazolam. Although the initial doses of intranasal dexmedetomidine and oral midazolam administered to patients varied widely, no significant differences were detected in the sedation outcomes among the groups. Multivariate analysis showed that sedation history, a history of sedation failure, and echocardiography were independent risk factors for sedation failure after an initial dose of intranasal dexmedetomidine and oral midazolam. In contrast, patients undergoing lung function and MRI were more likely to be successfully sedated.

Conclusion

A combination of low-dose intranasal dexmedetomidine and oral midazolam provides adequate sedation efficacy without any increase in side effects, especially for patients undergoing MRI or lung function examination.

Impact

  • This is an original article about the risk factors of sedation failure with an initial dose of intranasal dexmedetomidine and oral midazolam for procedure sedation.

  • For patients undergoing echocardiogram, it is better to choose other sedatives, while a combination of intranasal dexmedetomidine and oral midazolam is a good option for patients undergoing MRI or lung function.

  • The selection of sedative drugs should be personalized according to different procedures.

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Fig. 1
Fig. 2: The incidence of sedation failure among age groups.
Fig. 3: The incidence of sedation failure among different dose groups.
Fig. 4: The incidence of sedation failure among different procedures.

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Data availability

Datasets generated during and/or analyzed in the current study are available upon reasonable request to the corresponding author.

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Author information

Author notes

  1. These authors contributed equally: Yu Cui, Tianqing Gong.

Authors and Affiliations

  1. Department of Anesthesiology, The Affiliated Hospital, School of Medicine, UESTC Chengdu Women’s & Children’s Central Hospital, Chengdu, 610091, China

    Yu Cui, Tianqing Gong, Qixia Mu, Qunying Wu, Lu Kang, Qin Chen & Yani He

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  1. Yu Cui
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  2. Tianqing Gong
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  4. Qunying Wu
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Contributions

Y.C. and T.G. contributed to conceptualization, literature search, software, data analysis, writing of the original draft, reviewing and editing. Q.M., Q.W., L.K., Q.C., and Y.H. contributed to data collection. All the authors approved the final version of the manuscript.

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Correspondence to Yu Cui.

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Cui, Y., Gong, T., Mu, Q. et al. Predictors of pediatric sedation failure with initial dose of intranasal dexmedetomidine and oral midazolam. Pediatr Res 94, 2054–2061 (2023). https://doi.org/10.1038/s41390-023-02758-0

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