Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Italian Journal of Pediatrics
Published in: Italian Journal of Pediatrics 1/2019

Open Access 01-12-2019 | Magnetic Resonance Imaging | Case report

Intranasal dexmedetomidine and intravenous ketamine for procedural sedation in a child with alpha-mannosidosis: a magic bullet?

Authors: Matteo Trevisan, Sara Romano, Egidio Barbi, Irene Bruno, Flora Maria Murru, Giorgio Cozzi

Published in: Italian Journal of Pediatrics | Issue 1/2019

Login to get access

Abstract

Background

Procedural sedation is increasingly needed in pediatrics. Although different drugs or drugs association are available, which is the safest and most efficient has yet to be defined, especially in syndromic children with increased sedation-related risk factors.

Case report

we report the case of a five-year-old child affected by alpha-mannosidosis who required procedural sedation for an MRI scan and a lumbar puncture. We administered intranasal dexmedetomidine (4 μg/kg) 45 min before intravenous cannulation, followed by one bolus of ketamine (1 mg/kg) for each procedure. The patient maintained spontaneous breathing and no desaturation or any complication occurred.

Conclusion

intranasal dexmedetomidine and intravenous ketamine could be a feasible option for MRI and lumbar puncture in children with alpha-mannosidosis needing sedation.
Literature
1.
Pascolo P, Peri F, Montico M, et al. Needle-related pain and distress management during needle-related procedures in children with and without intellectual disability. Eur J Pediatr. 2018;177:1753–60.PubMedCrossRef
2.
Cozzi G, et al. Combination of intranasal dexmedetomidine and oral midazolam as sedation for pediatric MRI. Paediatr Anaesth. 2017;27:976–7.PubMedCrossRef
3.
4.
Lund AM, et al. Comprehensive long-term efficacy and safety of recombinant human alpha-mannosidase (velmanase alfa) treatment in patients with alpha-mannosidosis. J Inherit Metab Dis. 2018;41:1225–33.PubMedPubMedCentralCrossRef
5.
Walker R, et al. Anaesthesia and airway management in mucopolysaccharidosis. J Inherit Metab Dis. 2013;36:211–9.PubMedCrossRef
6.
Green SM, Roback MG, Kennedy RM, Krauss B. Clinical practice guideline for emergency department ketamine dissociative sedation: 2011 update. Ann Emerg Med. 2011;57:449–61.PubMedCrossRef
7.
Roback MG, Carlson DW, Babl FE, Kennedy RM. Update on pharmacological management of procedural sedation for children. Curr Opin Anaesthesiol. 2016;29:S21–35.PubMedCrossRef
8.
Green SM, et al. Predictors of Airway and Respiratory Adverse Events With Ketamine Sedation in the Emergency Department: An Individual-Patient Data Meta-analysis of 8,282 Children. Ann Emerg Med. 2009;54:158–168.e4.PubMedCrossRef
9.
Brown L, et al. Adjunctive atropine is unnecessary during ketamine sedation in children. Acad Emerg Med. 2008;15:314–8.PubMedCrossRef
10.
11.
Mahmoud M, Mason KP. Dexmedetomidine: review, update, and future considerations of paediatric perioperative and periprocedural applications and limitations. Br J Anaesth. 2015;115:171–82.PubMedCrossRef
12.
Ebert TJ, Hall JE, Barney JA, Uhrich TD, Colinco MD. The Effects of Increasing Plasma Concentrations of Dexmedetomidine in Humans. Anesthesiol J Am Soc Anesthesiol. 2000;93:382–94.
13.
Yuen VM, et al. ORIGINAL ARTICLE: optimal timing for the administration of intranasal dexmedetomidine for premedication in children. Anaesthesia. 2010;65:922–9.PubMedCrossRef
14.
15.
Ghai B, Jain K, Saxena AK, Bhatia N, Sodhi KS. Comparison of oral midazolam with intranasal dexmedetomidine premedication for children undergoing CT imaging: a randomized, double-blind, and controlled study. Pediatr Anesth. 2017;27:37–44.CrossRef
16.
Peng K, Wu S, Ji F, Li J. Premedication with dexmedetomidine in pediatric patients: a systematic review and meta-analysis. Clinics (Sao Paulo). 2014;69:777–86.CrossRef
17.
Cravero JP, et al. Incidence and Nature of Adverse Events During Pediatric Sedation/Anesthesia for Procedures Outside the Operating Room: Report From the Pediatric Sedation Research Consortium. Pediatrics. 2006;118:1087 LP–1096.CrossRef
18.
Cozzi G, Norbedo S, Barbi E. Intranasal Dexmedetomidine for procedural sedation in children, a suitable alternative to chloral hydrate. Pediatr Drugs. 2017;19:107–11.CrossRef
19.
Luscri N, Tobias JD. Monitored anesthesia care with a combination of ketamine and dexmedetomidine during magnetic resonance imaging in three children with trisomy 21 and obstructive sleep apnea. Paediatr Anaesth. 2006;16:782–6.PubMedCrossRef
20.
Kandil, A. et al. Comparison of the combination of dexmedetomidine and ketamine to propofol or propofol/sevoflurane for drug-induced sleep endoscopy in children. Pediatr. Anesth. 2016;26:742–751.CrossRef
21.
Kako H, et al. Dexmedetomidine and ketamine sedation for muscle biopsies in patients with Duchenne muscular dystrophy. Pediatr Anesth. 2014;24:851–6.CrossRef
22.
Goyal R, Shukla RN, Patra AK, Bhargava DV, Singh S. Ketodex, a combination of dexmedetomidine and ketamine for upper gastrointestinal endoscopy in children: a preliminary report. J Anesth. 2012;27:461–3.PubMedCrossRef
23.
Joshi VS, Kollu SS, Sharma RM. Comparison of dexmedetomidine and ketamine versus propofol and ketamine for procedural sedation in children undergoing minor cardiac procedures in cardiac catheterization laboratory. Ann Card Anaesth. 2017;20:422–6.PubMedPubMedCentralCrossRef
24.
Qiao H, Xie Z, Jia J. Pediatric premedication: a double-blind randomized trial of dexmedetomidine or ketamine alone versus a combination of dexmedetomidine and ketamine. BMC Anesthesiol. 2017;17:158.PubMedPubMedCentralCrossRef
25.
McVey JD, Tobias JD. Dexmedetomidine and ketamine for sedation during spinal anesthesia in children. J Clin Anesth. 2010;22:538–45.PubMedCrossRef
26.
Yang F, et al. Analysis of 17 948 pediatric patients undergoing procedural sedation with a combination of intranasal dexmedetomidine and ketamine. Pediatr Anesth. 2019;29:85–91.CrossRef
27.
Jia J-E, Chen J-Y, Hu X, Li W-X. A randomised study of intranasal dexmedetomidine and oral ketamine for premedication in children. Anaesthesia. 2013;68:944–9.PubMedCrossRef
28.
Rozmiarek A, Corridore M, Tobias JD. Dexmedetomidine-ketamine sedation during bone marrow aspirate and biopsy in a patient with duchenne muscular dystrophy. Saudi J Anaesth. 2011;5:219–22.PubMedPubMedCentralCrossRef
29.
Levanen J, Makela ML, Scheinin H. Dexmedetomidine premedication attenuates ketamine-induced Cardiostimulatory effects and Postanesthetic delirium. Anesthesiol J Am Soc Anesthesiol. 1995;82:1117–25.
Metadata
Title
Intranasal dexmedetomidine and intravenous ketamine for procedural sedation in a child with alpha-mannosidosis: a magic bullet?
Authors
Matteo Trevisan
Sara Romano
Egidio Barbi
Irene Bruno
Flora Maria Murru
Giorgio Cozzi
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Italian Journal of Pediatrics / Issue 1/2019
Electronic ISSN: 1824-7288
DOI
https://doi.org/10.1186/s13052-019-0711-1

Other articles of this Issue 1/2019

Italian Journal of Pediatrics 1/2019 Go to the issue

Case report

Ovotesticular differences of sex development: male or female? Case series

Case report

10-year experience with umbilical cord blood IgE and microbiome therapy

Commentary

Physical, psychological and social impact of school violence on children

Research

Analysis of the predicting factors of recurrent wheezing in infants

Case report

Hepatomegaly and type 1 diabetes: a clinical case of Mauriac’s syndrome

Letter to the Editor

Authors’ reply - anaphylactic shock with methylprednisolone, Kounis syndrome and Hypersitivity to corticosteroids: a clinical paradox