Combination of Intranasal Dexmedetomidine and Midazolam for Sedation in Pediatric Magnetic Resonance Imaging

Background: Intranasal dexmedetomidine associated with midazolam has been used for pediatric magnetic resonance imaging studies because immobility is a fundamental requirement for correct execution. Many studies have shown dexmedetomidine to be a good option for non-operating room sedation. However, identifying the optimal dose remains a key challenge, especially for pediatric patients. Methods: All medical records of 139 pediatric patients who underwent sedation for magnetic resonance imaging studies between September 2021 and November 2022 at the University Hospital of Salerno, Italy, were retrospectively reviewed about success rate and adverse events. Our protocol required dosing 30 minutes before the procedure. Patients weighing up to 40 kg received intranasal dexmedetomidine (3 mu g/kg) with intranasal midazolam (0.2 mg/kg). Those weighing more than 40 kg received intranasal dexmedetomidine (2 mu g/kg) with midazolam orally (0.3 mg/kg; maximum dose, 15 mg). Results: A total of 139 pediatric patients, with age range between 2 months and 16 years, median (95% confidence interval) of 3 (3-5) years, and weight range between 4 and 70 kg, median (95% confidence interval) of 19 (15-24) kg, were reviewed. The procedure was satisfactorily completed in 93.5% (130 patients) (P < 0.01). Only 9 (6.5%) patients completed the procedure with general anesthesia; there are hot adverse events. Conclusions: Our experience with association of intranasal dexmedetomidine and midazolam has a high success rate, with high effectiveness and safety.