Intranasal dexmedetomidine vs oral triclofos sodium for sedation of children with autism undergoing electroencephalograms. (March 2022)

• Record Type: Journal Article
• Authors: Kaplan, Eytan; Shifeldrim, Adi; Kraus, Dror; Weissbach, Avichai; Kadmon, Gili; Milkh, Rachel; Nahum, Elhanan
• Is Part Of: European journal of paediatric neurology. Volume 37(2022)
• Page Start: 19
• Page End: 24
• Publication Date: 2022-03
• Subjects: Autistic spectrum disorder -- Dexmedetomidine -- Electroencephalography -- Pediatric sedation -- Triclofos-sodium; Pediatric neurology -- Periodicals; Nervous System Diseases -- Periodicals; Child -- Periodicals; Infant -- Periodicals; Neurologie pédiatrique -- Périodiques; Pediatric neurology; Electronic journals; Periodicals; Electronic journals; 618.928
• DOI: 10.1016/j.ejpn.2022.01.005
• Languages: English
• ISSNs: 1090-3798

Abstract

Abstract: Background: Sedation may be necessary for performing electroencephalograms in children with autistic spectrum disorder, however, our sedation success rate using triclofos sodium (TFS) is limited. Intra-nasal dexmedetomidine (IN-DEX) may be a superior sedative for these children. Objective: Compare IN-DEX with TFS for sedation efficacy, resistance to drug delivery and adverse events in children with autism undergoing an electroencephalogram. Study design: A single center, prospective observational study of children with autism sedated for electroencephalograms using IN-DEX compared to an age matched, historic group of children with autism, sedated for electroencephalograms using TFS. Results: Characteristics of 41 IN-DEX sedations were compared to 41 TFS sedations in 82 ASD children. Epileptiform discharges were demonstrated in 23/82 (28%) of children in the cohort. Sedation depth by UMSS was significantly deeper in the IN-DEX group (2.49 ± 0.78 vs. 1.41 ± 0.89, p < 0.001). Electroencephalogram quality demonstrated less motion artifact in the IN-DEX group (1.75 ± 0.76 vs. 2.18 ± 0.88, p < 0.001). The rate of very poor or sedation failure was significantly lower in the IN-DEX group (17% vs 56.1%, p < 0.001), RR = 0.3 (95% CI 0.15 to 0.63, p < 0.001). No major adverse events were documented in either group. Bradycardia occurred in 8/41(19.5%) of children in IN-DEX group and none in TFS group (p = 0.003). Hypotension or poor perfusion were not demonstrated in either group. Conclusion: In children with autism undergoing electroencephalograms, IN-DEX was more tolerable than TFS, induced deeper sedation with a greater success rate, and improved electroencephalogram quality. Both sedatives were equally safe in this population. Highlights: What is known: Children with autistic spectrum disorder (ASD) may need sedation for performing EEG's. Triclofos-sodium has served as a mild sedative for many years, but efficacy in children with autism may be limited. Intra-nasally administered dexmedetomidine could serve as a better alternative for ASD children needing sedation for EEG. What This Study Adds: Intra-nasal dexmedetomidine was found to be superior to triclofos-sodium in children with autism undergoing EEG. Dexmedetomidine treated children achieved deeper sedation with higher success rates and better quality EEG's. Both sedatives were equally safe.