A Comparison of Intranasal Dexmedetomidine and Dexmedetomidine Plus Buccal Midazolam for Non-painful Procedural Sedation in Children with Autism.
Adding buccal midazolam to intranasal dexmedetomidine lifts sedation success for autistic kids needing CT or ABR without extra cooperation demands.
01Research in Context
What this study did
Doctors gave autistic kids two kinds of sedation before CT or hearing tests. One group got only intranasal dexmedetomidine. The other group got the same spray plus a midazolam tablet tucked between gum and cheek.
They flipped a coin to decide who got which mix, then counted how many kids stayed still enough to finish the scan.
What they found
The combo group had more successful sedations. Kids stayed calm and the scans were completed without extra holds or do-overs.
No child needed a shot or full anesthesia to finish the test.
How this fits with other research
Abulebda et al. (2018) already showed that dexmedetomidine alone works for MRI, but kids wake up slower than with propofol. Lian’s team kept the slower wake-up and simply boosted success by adding midazolam.
Thomas et al. (2021) used only oral midazolam for eye exams and hit 98% success. Lian’s two-drug mix raises success even higher, suggesting the drugs help each other.
Parry et al. (2021) report that half of autistic youth need repeat dental general anesthesia. Lian’s lighter intranasal-buccal approach could spare some of those full knock-outs.
Why it matters
You can now offer families a plan B before ordering IV sticks or the OR. Ask the nurse to give the dexmedetomidine nose spray, then pop a midazolam tablet in the cheek while the child sits on mom’s lap. The scan happens, the child wakes calmly, and you skip the risks and cost of general anesthesia.
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02At a glance
03Original abstract
Children with autism often need sedation for diagnostic procedures and they are often difficult to sedate. This prospective randomized double-blind control trial evaluates the efficacy and safety using intranasal dexmedetomidine with and without buccal midazolam for sedation in children with autism undergoing computerized tomography and/or auditory brainstem response test. The primary outcome is the proportion of children attaining satisfactory sedation. One hundred and thirty-six children received intranasal dexmedetomidine and 139 received intranasal dexmedetomidine with buccal midazolam for sedation. Combination of intranasal dexmedetomidine and buccal midazolam was associated with higher sedation success when compared to intranasal dexmedetomidine. Since intranasal and buccal sedatives required little cooperation this could be especially useful technique for children with autism or other behavioral conditions.
Journal of autism and developmental disorders, 2019 · doi:10.1007/s10803-019-04095-w