A Case Series of the Use of Intranasal Dexmedetomidine for Procedural Sedation in the Pediatric Emergency Department.

Procedural sedation in children has the propensity to result in costly hospital admissions and prolonged lengths of stay in emergency departments due to the coordination and resources required for completion. The use of intranasal (IN) dexmedetomidine in children for procedural sedation has been growing in popularity and demand in many clinical settings. Dexmedetomidine is a centrally acting alpha-2 agonist with anesthetic and anxiolytic properties, making it a useful option for sedation. Additional benefits of its use in the pediatric emergency department include high tolerability, decreased emotional distress of children, and ease of administration without need for parenteral access. Of the 18 pediatric patients who received IN dexmedetomidine for procedural sedation, 10 patients had successful procedural sedation solely with IN dexmedetomidine use. The success rate with IN dexmedetomidine was 63% for non-painful procedures (magnetic resonance imaging [MRI], computed tomography [CT]) and 57% for painful procedures (eye examinations, laboratory draw/intravenous [IV] placement, fracture reduction, foreign body removal). There were no documented adverse events with IN dexmedetomidine. Of the 18 patients, only 1 patient needed to return for a repeated scan and 2 patients were admitted owing to sedation needs. The use of IN dexmedetomidine in the pediatric emergency department provides a safe and less invasive option for sedation than commonly used sedatives. This leads to a reduced need for admissions dedicated to obtaining procedural sedation.