Title: Intranasal Dexmedetomidine Use in Pediatric Patients for Anxiolysis in the Emergency Department <br/>Author: Rachel Wiltjer<br/><a href='http://umem.org/profiles/resident/2046/'>[Click to email author]</a><hr/><div class="OutlineElement Ltr SCXW97864587 BCX0" segoe="" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; overflow: visible; cursor: text; clear: both; position: relative; direction: ltr; color: rgb(0, 0, 0); font-family: " ui="">
<p class="Paragraph SCXW97864587 BCX0" paraeid="{5f52de7f-bcef-45d5-b05b-38fdb80e2f48}{130}" paraid="2014965202" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; overflow-wrap: break-word; white-space: pre-wrap; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;">
<span style="font-family: Calibri, Calibri_EmbeddedFont, Calibri_MSFontService, sans-serif; font-size: 14.6667px; font-variant-ligatures: none; font-weight: 700;">Background:</span><strong> </strong><span class="NormalTextRun SCXW97864587 BCX0" style="font-family: Calibri, Calibri_EmbeddedFont, Calibri_MSFontService, sans-serif; font-size: 11pt; font-variant-ligatures: none; background-color: transparent; color: windowtext; margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;">Intranasal dexmedetomidine has seen usage in the anesthesia and sedation realms over the past few years, with an increasing in</span><span class="NormalTextRun SCXW97864587 BCX0" style="font-family: Calibri, Calibri_EmbeddedFont, Calibri_MSFontService, sans-serif; font-size: 11pt; font-variant-ligatures: none; background-color: transparent; color: windowtext; margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;">terest in usage in the ED setting given </span><span class="NormalTextRun SCXW97864587 BCX0" style="font-family: Calibri, Calibri_EmbeddedFont, Calibri_MSFontService, sans-serif; font-size: 11pt; font-variant-ligatures: none; background-color: transparent; color: windowtext; margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;">its</span><span class="NormalTextRun SCXW97864587 BCX0" style="font-family: Calibri, Calibri_EmbeddedFont, Calibri_MSFontService, sans-serif; font-size: 11pt; font-variant-ligatures: none; background-color: transparent; color: windowtext; margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;"> </span><span class="NormalTextRun SCXW97864587 BCX0" style="font-family: Calibri, Calibri_EmbeddedFont, Calibri_MSFontService, sans-serif; font-size: 11pt; font-variant-ligatures: none; background-color: transparent; color: windowtext; margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;">generally favorable</span><span class="NormalTextRun SCXW97864587 BCX0" style="font-family: Calibri, Calibri_EmbeddedFont, Calibri_MSFontService, sans-serif; font-size: 11pt; font-variant-ligatures: none; background-color: transparent; color: windowtext; margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;"> safety profile </span><span class="NormalTextRun SCXW97864587 BCX0" style="font-family: Calibri, Calibri_EmbeddedFont, Calibri_MSFontService, sans-serif; font-size: 11pt; font-variant-ligatures: none; background-color: transparent; color: windowtext; margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;">and ease of administration. </span><span class="NormalTextRun SCXW97864587 BCX0" style="font-family: Calibri, Calibri_EmbeddedFont, Calibri_MSFontService, sans-serif; font-size: 11pt; font-variant-ligatures: none; background-color: transparent; color: windowtext; margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;">There has been specific interest and consideration in children with autism and neurodevelopmental disorders. </span></p>
<p class="Paragraph SCXW97864587 BCX0" paraeid="{5f52de7f-bcef-45d5-b05b-38fdb80e2f48}{130}" paraid="2014965202" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; overflow-wrap: break-word; white-space: pre-wrap; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;">
<span class="TextRun SCXW97864587 BCX0" data-contrast="auto" lang="EN-US" style="background-color: transparent; color: windowtext; margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-size: 11pt; line-height: 19.425px; font-family: Calibri, Calibri_EmbeddedFont, Calibri_MSFontService, sans-serif; font-weight: bold; font-variant-ligatures: none !important;" xml:lang="EN-US">Study:</span><span class="TextRun SCXW97864587 BCX0" data-contrast="auto" lang="EN-US" style="background-color: transparent; color: windowtext; margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-size: 11pt; line-height: 19.425px; font-family: Calibri, Calibri_EmbeddedFont, Calibri_MSFontService, sans-serif; font-variant-ligatures: none !important;" xml:lang="EN-US"><span class="NormalTextRun SCXW97864587 BCX0" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;"> </span><span class="NormalTextRun SCXW97864587 BCX0" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;">Single center prospective provider study (compared to a </span><span class="NormalTextRun SCXW97864587 BCX0" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;">retrospective</span><span class="NormalTextRun SCXW97864587 BCX0" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;"> group</span><span class="NormalTextRun SCXW97864587 BCX0" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;"> of patients under 18 who received </span><span class="NormalTextRun SCXW97864587 BCX0" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;">oral </span><span class="NormalTextRun SCXW97864587 BCX0" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;">midazolam </span><span class="NormalTextRun SCXW97864587 BCX0" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;">for</span><span class="NormalTextRun SCXW97864587 BCX0" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;"> indications of agitation or </span><span class="NormalTextRun SCXW97864587 BCX0" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;">anxiety</span><span class="NormalTextRun SCXW97864587 BCX0" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;"> </span><span class="NormalTextRun SCXW97864587 BCX0" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;">via</span><span class="NormalTextRun SCXW97864587 BCX0" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;"> chart review) </span><span class="NormalTextRun SCXW97864587 BCX0" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;">looking at patients 6 months to 18 years of age with an order for intranasal </span><span class="NormalTextRun SCXW97864587 BCX0" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;">dexmedetomidine</span><span class="NormalTextRun SCXW97864587 BCX0" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;">. </span><span class="NormalTextRun SCXW97864587 BCX0" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;">Following use, a provider survey was completed to evaluate indication/rationale for use</span><span class="NormalTextRun SCXW97864587 BCX0" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;">, </span><span class="NormalTextRun SCXW97864587 BCX0" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;">satisfaction</span><span class="NormalTextRun SCXW97864587 BCX0" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;">, comfort with use, and perceived time to onset as well as duration of effect</span><span class="NormalTextRun SCXW97864587 BCX0" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;">.</span><span class="NormalTextRun SCXW97864587 BCX0" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;"> </span><span class="NormalTextRun SCXW97864587 BCX0" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;"> </span></span><span class="EOP SCXW97864587 BCX0" data-ccp-props="{" style="background-color: transparent; color: windowtext; margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-size: 11pt; line-height: 19.425px; font-family: Calibri, Calibri_EmbeddedFont, Calibri_MSFontService, sans-serif;"> </span></p>
<p class="Paragraph SCXW97864587 BCX0" paraeid="{5f52de7f-bcef-45d5-b05b-38fdb80e2f48}{130}" paraid="2014965202" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; overflow-wrap: break-word; white-space: pre-wrap; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;">
<span class="TextRun SCXW97864587 BCX0" data-contrast="auto" lang="EN-US" style="background-color: transparent; color: windowtext; margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-size: 11pt; line-height: 19.425px; font-family: Calibri, Calibri_EmbeddedFont, Calibri_MSFontService, sans-serif; font-weight: bold; font-variant-ligatures: none !important;" xml:lang="EN-US">Results: </span><span class="TextRun SCXW97864587 BCX0" data-contrast="auto" lang="EN-US" style="background-color: transparent; color: windowtext; margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-size: 11pt; line-height: 19.425px; font-family: Calibri, Calibri_EmbeddedFont, Calibri_MSFontService, sans-serif; font-variant-ligatures: none !important;" xml:lang="EN-US"><span class="NormalTextRun SCXW97864587 BCX0" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;">29% of patients receiving IN dexmedetomidine experienced treatment failure compared with </span><span class="NormalTextRun SCXW97864587 BCX0" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;">20.7% of patients receiving oral midazolam (not statistically significant). </span><span class="NormalTextRun SCXW97864587 BCX0" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;">In subgroup analysis, rates of treatment failure were lower for patients diagnosed with autism spectrum disorder receiving IN dexmedetomidine versus oral versed (</span><span class="NormalTextRun SCXW97864587 BCX0" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;">21.2% versus 66.7%)</span><span class="NormalTextRun SCXW97864587 BCX0" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;">. Length of stay was longer in the IN </span><span class="NormalTextRun SCXW97864587 BCX0" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;">dexmedetomidine</span><span class="NormalTextRun SCXW97864587 BCX0" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;"> group (6.0 hours versus 4.4 h</span><span class="NormalTextRun SCXW97864587 BCX0" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;">ours).</span><span class="NormalTextRun SCXW97864587 BCX0" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;"> Indication for use had variability between the two groups. </span></span><span class="EOP SCXW97864587 BCX0" data-ccp-props="{" style="background-color: transparent; color: windowtext; margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; font-size: 11pt; line-height: 19.425px; font-family: Calibri, Calibri_EmbeddedFont, Calibri_MSFontService, sans-serif;"> </span></p>
<p class="Paragraph SCXW97864587 BCX0" paraeid="{5f52de7f-bcef-45d5-b05b-38fdb80e2f48}{130}" paraid="2014965202" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; overflow-wrap: break-word; white-space: pre-wrap; vertical-align: baseline; font-kerning: none; background-color: transparent; color: windowtext;">
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<span class="TextRun SCXW144867645 BCX0" data-contrast="auto" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; color: rgb(0, 0, 0); white-space: pre-wrap; font-size: 11pt; line-height: 19.425px; font-family: Calibri, Calibri_EmbeddedFont, Calibri_MSFontService, sans-serif; font-weight: bold; font-variant-ligatures: none !important;" xml:lang="EN-US"><span class="NormalTextRun SCXW144867645 BCX0" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;">Bottom Line: </span><span class="NormalTextRun SCXW144867645 BCX0" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;">IN dexmedetomidine may be a reasonable agent to </span><span class="NormalTextRun SCXW144867645 BCX0" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;">utilize</span><span class="NormalTextRun SCXW144867645 BCX0" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;"> for anxiolysis in pediatric</span><span class="NormalTextRun SCXW144867645 BCX0" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;"> patients, especially those </span><span class="NormalTextRun SCXW144867645 BCX0" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;">who</span><span class="NormalTextRun SCXW144867645 BCX0" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;"> have previously had paradoxical</span><span class="NormalTextRun SCXW144867645 BCX0" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;"> reactions or poor efficacy of benzodiazepines. </span><span class="NormalTextRun SCXW144867645 BCX0" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;">It may be specifically useful when effects are desired for a slightly longer time</span><span class="NormalTextRun SCXW144867645 BCX0" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;"> and for non-painful/minimally painful interventions</span><span class="NormalTextRun SCXW144867645 BCX0" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;">. </span></span><span class="EOP SCXW144867645 BCX0" data-ccp-props="{" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; color: rgb(0, 0, 0); white-space: pre-wrap; font-size: 11pt; line-height: 19.425px; font-family: Calibri, Calibri_EmbeddedFont, Calibri_MSFontService, sans-serif;"> </span></p>
<fieldset><legend>References</legend>
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<span class="TextRun SCXW259330424 BCX0" data-contrast="none" lang="EN-US" style="font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; white-space: pre-wrap; color: rgb(33, 33, 33); font-size: 12pt; line-height: 20.5042px; font-family: Calibri, Calibri_EmbeddedFont, Calibri_MSFontService, sans-serif;" xml:lang="EN-US"><span class="NormalTextRun SCXW259330424 BCX0" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;">Kenneally A, Cummins M, Bailey A, Yackey K, Jones L, Carter C, Dugan A, Baum RA. Intranasal Dexmedetomidine Use in Pediatric Patients for Anxiolysis in the Emergency Department. </span><span 1px="" border-bottom:="" class="NormalTextRun SpellingErrorV2Themed SCXW259330424 BCX0" data:image="" solid="" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; background-repeat: repeat-x; background-position: left bottom; background-image: var(--urlSpellingErrorV2, url(">Pediatr</span><span class="NormalTextRun SCXW259330424 BCX0" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;"> Emerg Care. 2023 Jan 5. </span><span 1px="" border-bottom:="" class="NormalTextRun SpellingErrorV2Themed SCXW259330424 BCX0" data:image="" solid="" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; background-repeat: repeat-x; background-position: left bottom; background-image: var(--urlSpellingErrorV2, url(">Epub</span><span class="NormalTextRun SCXW259330424 BCX0" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;"> ahead of print</span><span class="NormalTextRun SCXW259330424 BCX0" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent;">. </span></span><span class="TextRun SCXW259330424 BCX0" data-contrast="auto" lang="EN-US" style="margin: 0px; padding: 0px; user-select: text; -webkit-user-drag: none; -webkit-tap-highlight-color: transparent; color: rgb(0, 0, 0); white-space: pre-wrap; font-size: 11pt; line-height: 19.425px; font-family: Calibri, Calibri_EmbeddedFont, Calibri_MSFontService, sans-serif; font-variant-ligatures: none !important;" xml:lang="EN-US"> </span></p>
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