Intranasal dexmedetomidine for procedural sedation

Key words: Dexmedetomidine, Procedural sedation, Children, Non-painful procedures

Sedation outside the operating theatre for diagnostic and therapeutic procedures in children is more and more frequently performed. Most of the sedative drugs commonly used in this setting, such as midazolam, chloral hydrate and propofol, may induce respiratory depression and apnoea. Dexmedetomidine is a high selective alpha2-adrenergic receptor agonist that acts in the locus coeruleus and induces a natural state of non-rapid eye movement sleep. Contrary to most of the other sedatives, it preserves respiratory drive. Moreover, it neither causes respiratory depression nor influences the patency and tone of the airways. Dexmedetomidine use in paediatrics has been extensively evaluated in clinical studies in the intensive care unit setting. Recently, substantial evidence has showed its efficacy and safety via the intranasal route outside the intensive care setting. Dexmedetomidine has only a minor analgesic effect, so its use is ideal for non-painful diagnostic radiological or instrumental procedures. The main adverse event reported with dexmedetomidine is a relative haemodynamic variability, which only rarely needs a medical support. All these features make dexmedetomidine use particularly interesting for non-painful procedures outside the operating theatre. However, in Italy its use via the intranasal route is still off-label.