Intranasal dexmedetomidine following failed chloral hydrate sedation in children

Chloral hydrate is the most commonly used sedative for paediatric diagnostic procedures in China with a success rate of around 80%. Intranasal dexmedetomidine is used for rescue sedation in our centre. This prospective investigation evaluated 213 children aged onemonth to 10years who were not adequately sedated following administration of chloral hydrate. Children were randomly assigned to receive rescue intranasal dexmedetomidine at 1g.kg(-1) (group 1), 1.5g.kg(-1) (group 2) or 2g.kg(-1) (group 3). The sedation level was assessed every 10min using a modified observer's assessment of alertness/sedation scale. Successful rescue sedation in groups 1, 2 and 3 were 56 (83.6%), 66 (89.2%) and 51 (96.2%), respectively. Increasing the rescue dose was associated with an increased success rate with an odds ratio of 4.12 (95% CI 1.13-14.98), p=0.032. We conclude that intranasal dexmedetomidine is effective for sedation in children who do not respond to chloral hydrate.