Outcomes of a nurse practitioner-led, intravenous dexmedetomidine-based pediatric sedation program for Magnetic Resonance Imaging in a general hospital.  A prospective observational study.

Purpose: Prospective observational study on the effectiveness and safety of a nurse practitioner-led pediatric sedation program for Magnetic Resonance Imaging (MRI) with intravenous dexmedetomidine in a Dutch general hospital. Methods: 115 children, aged 6 months to 11 years, scheduled for MRI, underwent 119 sedations with an intravenous (IV)-loading dose dexmedetomidine (3μgr/kg) followed by continuous infusion (2 μgr/kg/h). Great emphasis was put on non-pharmacological strategies to create a quiet environment and to reduce patients’ anxiety. The observed outcomes were sedation time, recovery time, Ramsay Sedation Scores (RSS), sedation failure and adverse events. Results: Median sedation time was 52 minutes (range 27-148 minutes). Median recovery time was 82 minutes (range 5-177 minutes). Deepest individual RSS ranged from 4 to 6 (11,8% deepest RSS 4, 69,3% deepest RSS 5, 18,8% deepest RSS 6). All sedations (100%) were successful. One patient (0,8%), experienced a brief episode of oxygen desaturation as low as 90%, rapidly resolving after low-flow oxygen therapy. Two patients (1,6%), experienced an episode of mild hypotension respectively during and immediately after dexmedetomidine administration. Both quickly normalized after a fluid bolus. One patient (0,8%) experienced post-sedation nausea. Conclusions: Sedation with intravenous dexmedetomidine for MRI can be safely and effectively entrusted to a competent nurse practitioner-led pediatric sedation team. To achieve high success rates, mastering the typical sedative characteristics of dexmedetomidine is essential, including the application of optimal logistics, consistent use of non-pharmacological comfort strategies and an effective, goal-directed collaboration between all involved.