Dexmedetomidine for electroencephalogram in children with behavioural disorders: a comparative study between intranasal and intravenous administration

The aim of the project was to compare the efficacy and safety of intranasal (IN) and intravenous (IV) dexmedetomidine (DEX) in procedural sedation for electroencephalogram (EEG) in paediatric patients with behavioural disorders.

Single-centre comparative observational study in the tertiary care centre of Padua, regarding all consecutive patients < 18 years old affected by behavioural disorders, who needed sedation for EEG recording. From 2018 to 2019 a group of children received IV administration of DEX, from 2020 to 2021 a second group of children received IN administration of the same drug. In both groups, the target of sedation was level 2, in accordance with the Paediatric Sedation State Scale (PSSS). Heart rate (HR), pulse oxygen saturation and blood pressure (BP) were registered. The quality of the EEG recordings and the satisfaction of caregivers were collected.

DEX was used in 48 patients (IV = 24; IN = 24) with total sedation success rate of 98%. Only one patient failed with IN DEX. IN DEX showed longer median onset time (p < 0.01), but shorter offset (p = 0.01) than IV route. All adverse effects were self-resolved. The IN group reported 9 cases of bradycardia, while hypotension and hypertension occurred in the IV group. EEG recording quality and level of satisfaction among caregivers and EEG technicians were high in both groups.

IN DEX is an effective sedative; its recovery time shorter than IV DEX and its favourable adverse events profile make this route a reasonable alternative, especially in paediatric patients with a low compliance to procedures.