Skip to main content
Intranasal Dexmedetomidine forProcedural Distress in Children: ASystematic Review
Pediatrics (2020)
  • Naveen Poonai, Western University
  • Joseph Spohn
  • Ben Vandermeer
  • Samina Ali
  • Maala Bhatt
  • Shawn Hendrikx
  • Evelyne D Trottier
  • Vikram Sabhaney
  • Amit Shah
  • Gary Joubert
  • Lisa Hartling
Intranasal dexmedetomidine (IND) is an emerging agent for procedural distress in children.

To explore the effectiveness of IND for procedural distress in children.

We performed electronic searches of Medline (19462019), Embase (19802019), Google Scholar (2019), Cumulative Index to Nursing and Allied Health Literature (19812019), and Cochrane Central Register.STUDY SELECTION:We included randomized trials of IND for procedures in children.

Methodologic quality of evidence was evaluated by using the Cochrane Collaborations risk of bias tool and the Grading of Recommendations Assessment, Development, and Evaluation system, respectively. The primary outcome was the proportion of participants with adequate sedation.

Among 19 trials (N= 2137), IND was superior to oral chloral hydrate (3 trials), oral midazolam (1trial), intranasal midazolam (1 trial), and oral dexmedetomidine (1 trial). IND was equivalent to oral chloralhydrate (2 trials), intranasal midazolam (2 trials), and intranasal ketamine (3 trials). IND was inferior to oral ketamine and a combination of IND plus oral ketamine (1 trial). Higher doses of IND were superior to lowerdoses (4 trials). Adverse effects were reported in 67 of 727 (9.2%) participants in the IND versus 98 of 591(16.6%) in the comparator group. There were no reports of adverse events requiring resuscitative measures.

The adequacy of sedation was subjective, which possibly led to biased outcome reporting.

Given the methodologic limitations of included trials, IND is likely more effective at sedating children compared to oral chloral hydrate and oral midazolam. However, this must be weighed against the potential for adverse cardiovascular effects.
Publication Date
January, 2020
Citation Information
Naveen Poonai, Joseph Spohn, Ben Vandermeer, Samina Ali, et al.. "Intranasal Dexmedetomidine forProcedural Distress in Children: ASystematic Review" Pediatrics (2020)
Available at: