STUDY OBJECTIVES
Adolescents with severe agitation may require repeated administration of sedatives. We describe dexmedetomidine infusion as a novel bridge therapy for selected agitated adolescents awaiting psychiatric treatment and disposition.
METHODS
We retrospectively studied adolescents (12 to 17 years) treated with dexmedetomidine infusion for severe agitation at our emergency department (ED) over a 16-month period. We abstracted demographics, sedatives administered, psychiatric therapy, type and frequency of adverse events, and ED disposition. Our primary outcome was the need for additional sedation despite dexmedetomidine.
RESULTS
The median age of our 20 qualifying patients was 15 years. The median duration of dexmedetomidine infusion was 21 hours, with a median maximum dose of 1.6 mcg/kg per hour. During the infusion, 9 patients (45%, 95% confidence interval 26% to 66%) required additional sedation. One patient experienced desaturation responding to head repositioning and supplemental oxygen. Five patients were transferred to the pediatric ICU owing to the need of multiple sedatives.
CONCLUSION
Our preliminary results support the feasibility of dexmedetomidine infusion as bridge sedation for selected severely agitated adolescents awaiting psychiatric care and disposition.
Giorgio Cozzi, Alessandro Zago, Alberto Di Mascio et al.· Annals of Emergency Medicine· 0 citations
Aim Preventing pain and distress during peripheral intravenous cannulation in children is essential to avoid long-term anxiety or needle phobia. This study evaluated whether combining EMLA cream with the Buzzy device is more effective than EMLA alone in reducing procedural distress and pain. Materials and methods We conducted a randomized controlled trial in two tertiary children's hospitals in Italy (March-October 2023). Children aged 4–12 years requiring intravenous cannulation were randomized to receive either EMLA alone or EMLA plus Buzzy. The primary outcome was distress, assessed by parents using the Children's Emotional Manifestation Scale (CEMS). Secondary outcomes included pain measured with the Faces Pain Scale-Revised (FPS-R) by children, parents, and healthcare operators, operator-rated distress, first-attempt success, and adverse events. Analyses followed an intention-to-treat basis. Results Ninety-four children (median age 8 years) were enrolled: 47 in the EMLA plus Buzzy group and 47 in the EMLA alone group. Parent-rated distress was significantly lower with EMLA plus Buzzy (median CEMS 6, IQR 5–7) than with EMLA alone (9, IQR 7–12; p = 0.001). Pain scores and first-attempt success rates were similar. No severe adverse events occurred. Conclusion Combining EMLA and Buzzy significantly reduced procedural distress perceived by parents without affecting pain scores.
Marco Persoglia, Irene Lapucci, Egidio Barbi et al.· Frontiers in Pediatrics· 0 citations
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