The sedative effects of the intranasal administration of dexmedetomidine in children undergoing surgeries compared to other sedation methods: A systematic review and meta-analysis

Hyun Jung Kim, Woo Jong Shin, Suin Park, Hyeong Sik Ahn, Jae Hoon Oh

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5 Citations (Scopus)

Abstract

Study objective Administration of intranasal dexmedetomidine for sedation is comfortable and effective in children who are afraid of needles, and it offers efficient sedation similar to that of intravenous administration. We performed a systematic review and meta-analysis to evaluate the clinical effects of the pre-procedural administration of intranasal dexmedetomidine. Design We identified randomized controlled trials (RCTs) that compared intranasal dexmedetomidine administration to other administration methods of various sedatives or placebo from MEDLINE, EMBASE, Cochrane, KoreaMed and hand searches of trial registries. Setting Pediatrics who underwent interventional procedures and surgeries. Patients Children under the age of 18. Interventions Studies were included if they were compatible with the criteria that dexmedetomidine was administered intranasally. Measurements We pooled data on the sedation status as the primary outcome and considered the behavioral score, blood pressure, heart rate and side effects to be secondary outcomes. Risk ratio (RR) and the standardized mean difference (SMD) with 95% confidence intervals (CIs) were calculated for dichotomous and continuous outcomes, respectively. Main results This meta-analysis included 11 RCTs. The SMD for the sedative effects of intranasal dexmedetomidine was − 2.45 (random, 95% CI; − 3.33, − 1.58) for continuous outcomes and RR of unsatisfactory patient outcome was 0.42 (M-H, random 95% CI; 0.26, 0.68 I2 = 45%) for dichotomous outcomes compared to that of intranasal saline. The SMD for the sedative effects of intranasal dexmedetomidine was − 0.41 (random, 95% CI; − 1.09, 0.27 I2 = 69%) for continuous outcomes and RR was 0.43 (M-H, random 95% CI; 0.32, 0.58 I2 = 0%) for dichotomous outcomes compared to that of per os benzodiazepines. Conclusions This review suggests that intranasal dexmedetomidine is associated with better sedative effects than oral benzodiazepines without producing respiratory depression, but it had a significantly delayed onset of effects.

Original languageEnglish
Pages (from-to)33-39
Number of pages7
JournalJournal of Clinical Anesthesia
Volume38
DOIs
StatePublished - 2017 May 1

Fingerprint

Dexmedetomidine
Intranasal Administration
Hypnotics and Sedatives
Meta-Analysis
Confidence Intervals
Odds Ratio
Benzodiazepines
Randomized Controlled Trials
MEDLINE
Respiratory Insufficiency
Intravenous Administration
Needles
Registries
Heart Rate
Placebos
Pediatrics
Blood Pressure

Keywords

  • Dexmedetomidine
  • Intranasal
  • Meta-analysis
  • Randomized controlled trials
  • Sedation
  • Systematic review

Cite this

@article{a569191903fd445caa112f492aca8ac8,
title = "The sedative effects of the intranasal administration of dexmedetomidine in children undergoing surgeries compared to other sedation methods: A systematic review and meta-analysis",
abstract = "Study objective Administration of intranasal dexmedetomidine for sedation is comfortable and effective in children who are afraid of needles, and it offers efficient sedation similar to that of intravenous administration. We performed a systematic review and meta-analysis to evaluate the clinical effects of the pre-procedural administration of intranasal dexmedetomidine. Design We identified randomized controlled trials (RCTs) that compared intranasal dexmedetomidine administration to other administration methods of various sedatives or placebo from MEDLINE, EMBASE, Cochrane, KoreaMed and hand searches of trial registries. Setting Pediatrics who underwent interventional procedures and surgeries. Patients Children under the age of 18. Interventions Studies were included if they were compatible with the criteria that dexmedetomidine was administered intranasally. Measurements We pooled data on the sedation status as the primary outcome and considered the behavioral score, blood pressure, heart rate and side effects to be secondary outcomes. Risk ratio (RR) and the standardized mean difference (SMD) with 95{\%} confidence intervals (CIs) were calculated for dichotomous and continuous outcomes, respectively. Main results This meta-analysis included 11 RCTs. The SMD for the sedative effects of intranasal dexmedetomidine was − 2.45 (random, 95{\%} CI; − 3.33, − 1.58) for continuous outcomes and RR of unsatisfactory patient outcome was 0.42 (M-H, random 95{\%} CI; 0.26, 0.68 I2 = 45{\%}) for dichotomous outcomes compared to that of intranasal saline. The SMD for the sedative effects of intranasal dexmedetomidine was − 0.41 (random, 95{\%} CI; − 1.09, 0.27 I2 = 69{\%}) for continuous outcomes and RR was 0.43 (M-H, random 95{\%} CI; 0.32, 0.58 I2 = 0{\%}) for dichotomous outcomes compared to that of per os benzodiazepines. Conclusions This review suggests that intranasal dexmedetomidine is associated with better sedative effects than oral benzodiazepines without producing respiratory depression, but it had a significantly delayed onset of effects.",
keywords = "Dexmedetomidine, Intranasal, Meta-analysis, Randomized controlled trials, Sedation, Systematic review",
author = "Kim, {Hyun Jung} and Shin, {Woo Jong} and Suin Park and Ahn, {Hyeong Sik} and Oh, {Jae Hoon}",
year = "2017",
month = "5",
day = "1",
doi = "10.1016/j.jclinane.2017.01.014",
language = "English",
volume = "38",
pages = "33--39",
journal = "Journal of Clinical Anesthesia",
issn = "0952-8180",

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TY - JOUR

T1 - The sedative effects of the intranasal administration of dexmedetomidine in children undergoing surgeries compared to other sedation methods

T2 - A systematic review and meta-analysis

AU - Kim, Hyun Jung

AU - Shin, Woo Jong

AU - Park, Suin

AU - Ahn, Hyeong Sik

AU - Oh, Jae Hoon

PY - 2017/5/1

Y1 - 2017/5/1

N2 - Study objective Administration of intranasal dexmedetomidine for sedation is comfortable and effective in children who are afraid of needles, and it offers efficient sedation similar to that of intravenous administration. We performed a systematic review and meta-analysis to evaluate the clinical effects of the pre-procedural administration of intranasal dexmedetomidine. Design We identified randomized controlled trials (RCTs) that compared intranasal dexmedetomidine administration to other administration methods of various sedatives or placebo from MEDLINE, EMBASE, Cochrane, KoreaMed and hand searches of trial registries. Setting Pediatrics who underwent interventional procedures and surgeries. Patients Children under the age of 18. Interventions Studies were included if they were compatible with the criteria that dexmedetomidine was administered intranasally. Measurements We pooled data on the sedation status as the primary outcome and considered the behavioral score, blood pressure, heart rate and side effects to be secondary outcomes. Risk ratio (RR) and the standardized mean difference (SMD) with 95% confidence intervals (CIs) were calculated for dichotomous and continuous outcomes, respectively. Main results This meta-analysis included 11 RCTs. The SMD for the sedative effects of intranasal dexmedetomidine was − 2.45 (random, 95% CI; − 3.33, − 1.58) for continuous outcomes and RR of unsatisfactory patient outcome was 0.42 (M-H, random 95% CI; 0.26, 0.68 I2 = 45%) for dichotomous outcomes compared to that of intranasal saline. The SMD for the sedative effects of intranasal dexmedetomidine was − 0.41 (random, 95% CI; − 1.09, 0.27 I2 = 69%) for continuous outcomes and RR was 0.43 (M-H, random 95% CI; 0.32, 0.58 I2 = 0%) for dichotomous outcomes compared to that of per os benzodiazepines. Conclusions This review suggests that intranasal dexmedetomidine is associated with better sedative effects than oral benzodiazepines without producing respiratory depression, but it had a significantly delayed onset of effects.

AB - Study objective Administration of intranasal dexmedetomidine for sedation is comfortable and effective in children who are afraid of needles, and it offers efficient sedation similar to that of intravenous administration. We performed a systematic review and meta-analysis to evaluate the clinical effects of the pre-procedural administration of intranasal dexmedetomidine. Design We identified randomized controlled trials (RCTs) that compared intranasal dexmedetomidine administration to other administration methods of various sedatives or placebo from MEDLINE, EMBASE, Cochrane, KoreaMed and hand searches of trial registries. Setting Pediatrics who underwent interventional procedures and surgeries. Patients Children under the age of 18. Interventions Studies were included if they were compatible with the criteria that dexmedetomidine was administered intranasally. Measurements We pooled data on the sedation status as the primary outcome and considered the behavioral score, blood pressure, heart rate and side effects to be secondary outcomes. Risk ratio (RR) and the standardized mean difference (SMD) with 95% confidence intervals (CIs) were calculated for dichotomous and continuous outcomes, respectively. Main results This meta-analysis included 11 RCTs. The SMD for the sedative effects of intranasal dexmedetomidine was − 2.45 (random, 95% CI; − 3.33, − 1.58) for continuous outcomes and RR of unsatisfactory patient outcome was 0.42 (M-H, random 95% CI; 0.26, 0.68 I2 = 45%) for dichotomous outcomes compared to that of intranasal saline. The SMD for the sedative effects of intranasal dexmedetomidine was − 0.41 (random, 95% CI; − 1.09, 0.27 I2 = 69%) for continuous outcomes and RR was 0.43 (M-H, random 95% CI; 0.32, 0.58 I2 = 0%) for dichotomous outcomes compared to that of per os benzodiazepines. Conclusions This review suggests that intranasal dexmedetomidine is associated with better sedative effects than oral benzodiazepines without producing respiratory depression, but it had a significantly delayed onset of effects.

KW - Dexmedetomidine

KW - Intranasal

KW - Meta-analysis

KW - Randomized controlled trials

KW - Sedation

KW - Systematic review

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DO - 10.1016/j.jclinane.2017.01.014

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C2 - 28372674

AN - SCOPUS:85009198016

VL - 38

SP - 33

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JO - Journal of Clinical Anesthesia

JF - Journal of Clinical Anesthesia

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