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A prospective, randomized, double-blind trial of intranasal dexmedetomidine and oral chloral hydrate for sedated auditory brainstem response (ABR) testing.
Paediatr Anaesth 2016; 26(3):286-93PA

Abstract

BACKGROUND

Dexmedetomidine is increasingly used by various routes for pediatric sedation. However, there are few randomized controlled trials comparing the efficacy of dexmedetomidine to other commonly used sedatives.

AIM

To compare the efficacy of sedation with intranasal dexmedetomidine to oral chloral hydrate for auditory brainstem response (ABR) testing.

METHODS

In this double-blind, double-dummy study, children undergoing ABR testing were randomized to receive intranasal dexmedetomidine 3 mcg · kg(-1) plus oral placebo (Group IN DEX) or oral chloral hydrate 50 mg · kg(-1) plus intranasal saline placebo (Group CH). We recorded demographic data, times from sedative administration to start and completion of testing, quality of sedation, occurrence of predefined adverse events, discharge times, and return to baseline activity on the day of testing.

RESULTS

Testing completion rates with a single dose of medication were higher in the IN DEX group (89% vs 66% for CH, odds ratio with 95% confidence intervals 4.04 [1.3-12.6], P = 0.018). The median [95% CI)] time to successful testing start was shorter (25 [20-29] min vs 30 [20-49] min for IN DEX and CH, respectively, log rank test P = 0.02) and the proportion of children whose parents reported a return to baseline activity on the day of testing was greater for the IN DEX than the CH group (89% vs 64%, OR [95% CI] 4.71 [1.34-16.6], P = 0.02). There were no major adverse events in either group and no significant differences in the incidence of minor events.

CONCLUSION

Intranasal dexmedetomidine is an effective alternative to oral chloral hydrate sedation for ABR testing, with the advantages of a higher incidence of testing completion with a single dose, shorter time to desired sedation level, and with significantly more patients reported to return to baseline activity on the same day.

Authors+Show Affiliations

Department of Pediatrics, Section of Hospital Medicine, Baylor College of Medicine, Houston, TX, USA. Department of Medicine, Section of Pediatric Hospital Medicine, Children's Hospital of San Antonio, San Antonio, TX, USA.Department of Pediatrics, Section of Hospital Medicine, Baylor College of Medicine, Houston, TX, USA. Department of Pediatric Anesthesiology, Texas Children's Hospital, Houston, TX, USA.Department of Pediatric Anesthesiology, Texas Children's Hospital, Houston, TX, USA. Department of Anesthesiology, Section of Pediatric Anesthesiology, Baylor College of Medicine, Houston, TX, USA.Department of Pediatric Anesthesiology, Texas Children's Hospital, Houston, TX, USA. Department of Anesthesiology, Section of Pediatric Anesthesiology, Baylor College of Medicine, Houston, TX, USA.Department of Pediatric Anesthesiology, Texas Children's Hospital, Houston, TX, USA. Department of Anesthesiology, Section of Pediatric Anesthesiology, Baylor College of Medicine, Houston, TX, USA.

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26814038

Citation

Reynolds, Jason, et al. "A Prospective, Randomized, Double-blind Trial of Intranasal Dexmedetomidine and Oral Chloral Hydrate for Sedated Auditory Brainstem Response (ABR) Testing." Paediatric Anaesthesia, vol. 26, no. 3, 2016, pp. 286-93.
Reynolds J, Rogers A, Medellin E, et al. A prospective, randomized, double-blind trial of intranasal dexmedetomidine and oral chloral hydrate for sedated auditory brainstem response (ABR) testing. Paediatr Anaesth. 2016;26(3):286-93.
Reynolds, J., Rogers, A., Medellin, E., Guzman, J. A., & Watcha, M. F. (2016). A prospective, randomized, double-blind trial of intranasal dexmedetomidine and oral chloral hydrate for sedated auditory brainstem response (ABR) testing. Paediatric Anaesthesia, 26(3), pp. 286-93. doi:10.1111/pan.12854.
Reynolds J, et al. A Prospective, Randomized, Double-blind Trial of Intranasal Dexmedetomidine and Oral Chloral Hydrate for Sedated Auditory Brainstem Response (ABR) Testing. Paediatr Anaesth. 2016;26(3):286-93. PubMed PMID: 26814038.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A prospective, randomized, double-blind trial of intranasal dexmedetomidine and oral chloral hydrate for sedated auditory brainstem response (ABR) testing. AU - Reynolds,Jason, AU - Rogers,Amber, AU - Medellin,Eduardo, AU - Guzman,Jonathan A, AU - Watcha,Mehernoor F, PY - 2015/12/28/accepted PY - 2016/1/28/entrez PY - 2016/1/28/pubmed PY - 2016/12/15/medline KW - administration KW - auditory KW - brainstem KW - chloral hydrate KW - dexmedetomidine KW - evoked potentials KW - hypnotics and sedatives KW - intranasal SP - 286 EP - 93 JF - Paediatric anaesthesia JO - Paediatr Anaesth VL - 26 IS - 3 N2 - BACKGROUND: Dexmedetomidine is increasingly used by various routes for pediatric sedation. However, there are few randomized controlled trials comparing the efficacy of dexmedetomidine to other commonly used sedatives. AIM: To compare the efficacy of sedation with intranasal dexmedetomidine to oral chloral hydrate for auditory brainstem response (ABR) testing. METHODS: In this double-blind, double-dummy study, children undergoing ABR testing were randomized to receive intranasal dexmedetomidine 3 mcg · kg(-1) plus oral placebo (Group IN DEX) or oral chloral hydrate 50 mg · kg(-1) plus intranasal saline placebo (Group CH). We recorded demographic data, times from sedative administration to start and completion of testing, quality of sedation, occurrence of predefined adverse events, discharge times, and return to baseline activity on the day of testing. RESULTS: Testing completion rates with a single dose of medication were higher in the IN DEX group (89% vs 66% for CH, odds ratio with 95% confidence intervals 4.04 [1.3-12.6], P = 0.018). The median [95% CI)] time to successful testing start was shorter (25 [20-29] min vs 30 [20-49] min for IN DEX and CH, respectively, log rank test P = 0.02) and the proportion of children whose parents reported a return to baseline activity on the day of testing was greater for the IN DEX than the CH group (89% vs 64%, OR [95% CI] 4.71 [1.34-16.6], P = 0.02). There were no major adverse events in either group and no significant differences in the incidence of minor events. CONCLUSION: Intranasal dexmedetomidine is an effective alternative to oral chloral hydrate sedation for ABR testing, with the advantages of a higher incidence of testing completion with a single dose, shorter time to desired sedation level, and with significantly more patients reported to return to baseline activity on the same day. SN - 1460-9592 UR - https://www.unboundmedicine.com/medline/citation/26814038/A_prospective_randomized_double_blind_trial_of_intranasal_dexmedetomidine_and_oral_chloral_hydrate_for_sedated_auditory_brainstem_response__ABR__testing_ L2 - https://doi.org/10.1111/pan.12854 DB - PRIME DP - Unbound Medicine ER -