Nurse-driven intranasal dexmedetomidine administration as sedation for non-invasive procedures in children: a single center audit.

Purpose To audit the efficacy and safety of intranasal dexmedetomidine sedation for non-invasive procedural sedation in children provided by nurses of the procedural sedation (PROSA) team in the University Hospitals Leuven. Efficacy (successful sedation as sole sedative) and safety (cardiorespiratory monitoring, saturation) were hereby assessed. Methods In this audit, prospectively recorded data were extracted from the medical files in 772 patients between 4 weeks to 18 years old, who underwent sedation with intranasal dexmedetomidine (2–4 µg/kg) by the nurse-driven PROSA team. Results 90.7% of the patients were successfully sedated (single dose, monotherapy), 60 patients (7.8%) needed an additional intervention during sedation, of whom 37 (4.8%) needed an extra dose of intranasal dexmedetomidine and 14 (1.8%) received an additional other sedative. Successful sedation rates were higher in younger children, and medical imaging was the most common indication. Sedation failed in 12 (1.6%) patients, with 10 of them failed to fall asleep. Adverse events were limited in number (n = 13, 1.7%) and severity: 4 patients had a low heart rate (one treated with atropine), one had an irregular heart rate, and 7 desaturation events were described. Hypotension was treated with normal saline in one case. Conclusions In this nurse-driven PROSA setting, intranasal dexmedetomidine is effective and safe for non-invasive procedural sedation in paediatric patients.