Intranasal Dexmedetomidine Sedation in Children for Non-painful Procedures

Dexmedetomidine (DEX) is an alpha-2 receptor agonist with sedative, anxiolytic, and
analgesics properties. DEX has been used extensively for sedation in children to facilitate
different non-painful procedures, such magnetic resonance imaging (MRI), auditory brainstem
response (ABR) tests, and computed tomography (CT) scans. In particular, DEX can be
administered by the intranasal (IN) route. Intranasal administration has the benefits of
being both effective and needle-free, of which the latter makes it less distressing to
children compared to sedatives administered by the intravenous (IV) route. There is a gap of
knowledge, however, regarding the ideal regimen of IN DEX for providing optimal procedural
sedation in children undergoing non-painful procedures. There is a large variation in
practice using IN DEX, both regarding the dose and the use of adjunct medications. It is also
unknown whether regimens should vary based on patient factors such as age. There is no clear
evidence to define best practice when using IN DEX to provide sedation in this population to
achieve the desired outcomes most relevant to clinicians. The rationale of the proposed
investigation is that by conducting an exploratory study to measure clinical outcomes
associated with IN DEX, the investigators can begin to identify trends and differences that
will lay the foundation for randomized clinical trials to identify the ideal regimen for IN
DEX when providing sedation for non-painful procedures. This will then allow the
investigators to compare IN DEX, at its best, to other sedatives so that the sedative and
regimen associated with the best outcomes relevant to sedation of children undergoing
non-painful procedures can be determined.

Inclusion Criteria:

- Children 2 months to 17 years (i.e. before their 18th birthday)

- Child will be receiving intranasal dexmedetomidine as part of their usual medical care

- Child will be undergoing a non-painful medical procedure, which includes (but is not
limited to): MRI, CT scans, ABR/BAER, echocardiograms, and EEGs.

Exclusion Criteria:

- Known allergy to dexmedetomidine

- Known abnormal renal or hepatic function

- Known cardiac conduction abnormality or heart block

- Current use of digoxin or beta-blockers