Intranasal Dexmedetomidine with Propofol Provides Superior Sedation for Pediatric Contrast-Enhanced CT: A Randomized Controlled Trial
Year: 2025
Type: article
Abstract: Su-Jing Zhang,1– 3,* Yan-Jun Weng,1,* Qian Lei,1 Min-Yi Lin,1 Hua-Lin Chen,1,4,* Tuan-Fang Fang,1,3,* Guo-Lin Lu1,3,* 1Fujian Children’s Hospital (Fujian Branch of Shanghai Children’s Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, People’s Republic of China; 2Department of Anesthesiology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, People’s Republic of China; 3Fujian Key Laboratory of Women and Children’s Critical Diseases Research, Fuzhou, People’s Republic of China; 4Department of Anesthesia, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, People’s Republic of China*These authors contributed equally to this workCorrespondence: Guo-Lin Lu, Fujian Children’s Hospital (Fujian Branch of Shanghai Children’s Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, People’s Republic of China, Tel +86-18059007715, Email [email protected]: Effective and safe sedation with rapid recovery remains a critical unmet need for pediatric patients undergoing contrast-enhanced computed tomography (contrast-enhanced CT). We compared the efficacy of intranasal dexmedetomidine (DEX) combined with intravenous propofol (D-P) versus DEX with buccal midazolam (D-M) for sedation during pediatric contrast-enhanced CT.Methods: In this single-center, prospective, randomized controlled trial, 110 children (6 months– 6 years, ASA I/II) were allocated to D-M (2 μg/kg intranasal DEX + 0.2 mg/kg buccal midazolam) or D-P (2 μg/kg intranasal DEX + 1 mg/kg intravenous propofol). Primary outcome was one-time success rate (completed contrast-enhanced CT without additional sedation). Secondary outcomes included onset time, recovery metrics (Ramsay Sedation Scale [RSS] at 30 minutes, time to oral intake), and adverse events. Analyses followed full-analysis-set (FAS) and per-protocol-set (PPS) principles (ChiCTR2300067469).Results: The D-P group demonstrated superior one-time success rates in both FAS (96.4% vs 74.5%; OR 9.05, 95% CI 1.95– 42.05, P =0.001) and PPS analyses (96.4% vs 77.1%; OR 7.88, 95% CI 1.65– 37.6, P =0.003). Sedation onset was faster with D-P (median 17 vs 20 minutes, P < 0.001), with 98.2% achieving sleep within 20 minutes versus 54.5% for D-M. Recovery was accelerated in D-P: 61.8% attained RSS ≤ 3 by 30 minutes (vs 30.9%, P < 0.001), and 77.3% resumed oral intake within 1 hour (vs 25.4%, P < 0.001). Bradycardia occurred more frequently with D-P (29.1% vs 5.4%, P =0.001), but no interventions were required.Conclusion: Intranasal dexmedetomidine combined with propofol significantly improves sedation success, accelerates recovery, and reduces procedural delays in pediatric contrast-enhanced CT compared to midazolam, offering a clinically advantageous regimen for short-duration imaging.Keywords: dexmedetomidine, propofol, midazolam, sedation, pediatrics, computed tomography
Authors: Zhang SJ, Weng YJ, Lei Q, Lin MY, Chen HL, Fang TF, Lu GL
Language: English
Subfield: Anesthesiology and Pain Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7094977209
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