Dexmedetomidine for Electroencephalogram in patients with behavioural disorders: a comparative study between intranasal and intravenous administration

Study Objective: The aim of the project was to compare the efficacy and safety of intranasal and intravenous dexmedetomidine (DEX) in procedural sedation for electroencephalogram (EEG) in patients with behavioural disorders. Design: observational monocentric comparative study Setting: Tertiary care centre Emergency Department Patients: all consecutive patients < 18 years old affected by behavioural disorders, who needed sedation for EEG recording. From 2018 to 2020 a group of children received intravenous administration of DEX, the following year a second group of children received intranasal administration of the same drug. Target of sedation was level 2, according to the Paediatric Sedation State Scale (PSSS) in both groups. Heart rate (HR), pulse oxygen saturation and blood pressure (BP) were registered. EEG recording quality and caregivers’ satisfaction were collected. Results: Twenty-four patients were sedated with intravenous and other twenty-four with intranasal DEX. Sedation success rate was 97.9%. Intranasal administration showed longer onset (p <0.0001), but shorter offset (p 0.0145); 45.8% patients reported adverse effects. Bradycardia occurred in 35.4% of the overall population, cases of hypotension were still reported in the intravenous group. All adverse effects were self-resolved without any intervention. EEG recording quality and level of satisfaction among caregivers and EEG technicians were high. Conclusions: Considering our data dexmedetomidine is an effective and safe drug in patients with behavioural disorders. Intranasal administration could be useful as it is less invasive and with shorter offset. Clinical Trial registration ID NCT 03799783; date registered 10/01/2019