Comparison of a ready-to-use intranasal dexmedetomidine spray with traditional intranasal dexmedetomidine drops for sedation in preschool children: a prospective, randomized, controlled study

Purpose This study compared the efficacy and acceptability of a ready-to-use intranasal dexmedetomidine spray (DS) versus traditional drops administered by syringe (DD) in pediatric patients undergoing elective surgery. Patients and Methods Eighty-six preschool children were enrolled in a prospective, randomized, controlled study. Children were randomly assigned to receive either DS or DD. For children weighing between 10.5 and 18.5 kg, a dexmedetomidine dosage of 30 mu g (two sprays) was administered, while those weighing between 18.5 and 25.5 kg received 45 mu g (three sprays). In the DD group, dexmedetomidine was administered at a dose of 2 mu g/kg based on body weight. The primary outcome was the proportion of children achieving a Ramsay sedation scale (RSS) score of >= 3 within 30 min. Secondary outcomes included acceptance of intranasal medication, anxiety at parental separation and prior to induction, and compliance with induction. Results A total of 83 cases were analyzed. The proportion of children achieving an RSS score of >= 3 within 30 min was similar between the DS and DD groups (90.7% vs. 77.5%, respectively). However, the acceptance score was significantly better in the DS group (mean difference [95%]: -0.9 [-1.267 to -0.5325], P < 0.001). No significant differences were observed between the groups in terms of successful child-parent separation (88.4% vs. 85%) or satisfactory anxiolytic effect prior to induction (95.3% vs. 92.5%). Compliance with induction was comparable, with 53.5% in the DS group and 40.0% in the DD group demonstrating "optimal" compliance. Conclusion Both intranasal spray and syringe drop methods were highly effective in providing sedation and anxiolysis, but the ready-to-use intranasal dexmedetomidine spray was more acceptable to children, offering a viable alternative to the syringe method. Clinical Trial Registration ChiCTR.org.cn, identifier ChiCTR2400089374.