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IM Dexmedetomidine(precedex) will it be the ideal agent for Kids sedation?



Kids who require sedation for CT or MR imaging would ideally be managed

1- without placing an IV (in contrast to propofol and etomidate)
2- Using an agent that does not cause significant cardiorespiratory depression (in contrast to Opioids)
3- Safe and predictable levels (in contrast to chloral hydrate, which is also unpredictable, untitratable, and lasts forever)
4- Minimal side effects (in contrast to ketamine).

All of this pushed physicians to use  Precedex in Pediatrics Procedural sedation using IM route.

American Journal of Roentgenology reported a case series  of  65 consecutive children sedated for CT or MRI with intramuscular dexmedetomidine, administered either once or twice at a dose of 1-4 mcg/kg, the exact dose left to provider discretion, to achieve a target Ramsay score of 4 (asleep but briskly responsive to a light stimulus).

4 patients out of 65 required a second IM dose to achieve a Ramsay score of 4. Once Ramsay 4 was achieved, no other agents were given for the duration of the procedure. The mean dose was about 2.5 mcg/kg.

All 65 children successfully completed the study. Though 9 out of 65 patients developed transient hypotension, there were no adverse events that required intervention. 65 patients is not enough to conclusively demonstrate safety, but 100% efficacy is hard to beat, and I suspect the safety profile will stand up in larger series.

Average time to sedation was 13 minutes. The average time from the end of the study to recovery was 22 minutes in the MRI group and 17 minutes in the CT group, with wide confidence intervals, i.e. there was no difference in recovery times. Since MRI is significantly longer than CT, and no sedatives were administered after the initial dose, how can this be?

Mason KP, Lubisch NB, Robinson F, Roskos R. Intramuscular dexmedetomidine sedation for pediatric MRI and CT. American Journal of Roentgenology 2011 Sep;197(3):720-5.
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