Anna Nikula, pediatric emergency physician (formerly Astrid Lindgren Children’s Hospital, Stockholm 2010-2017; now Finland), presents RCTs on intranasal dexmedetomidine (IN-DEX) for procedural sedation/analgesia (PSA) in kids, evaluating analgesia/sedation vs. standards and behavioral impacts.
Study 1 (double-blind superiority RCT, 1-3yo healthy w/ minor trauma): IN-DEX (2mcg/kg) vs. IN-esketamine; underpowered (n=30). Lower FLACC pain (physician-assessed) w/ DEX but non-sig.; deeper sedation trend. Study 2 (open non-inferiority RCT, 3-15yo w/ fracture/luxation): IN-DEX vs. 50% nitrous oxide (N2O); DEX non-inferior (median FLACC 4 both; 95%CI met).
Secondaries: High parental satisfaction (>90%); 82-94% would reuse (kids/parents); feasible for ED docs. N2O: more nausea/vomiting/hallucinations; no serious cardioresp events. Follow-up (n=148, post-N2O/DEX): 4.5% negative behaviors (fear/clinging); 3% positive (less doctor-fear, play-acting).
Conclusion: IN-DEX provides adequate analgesia/sedation for minor trauma/fracture reduction (w/ paracetamol/local anesthetic); viable alternative to IN-esketamine/N2O, esp. resource-poor settings. Dosing: 2-3mcg/kg ideal (faster/higher risks at 4mcg/kg). Overcomes pain myth via combos. Q&A: Still relevant (limited IN-DEX data); combine w/ analgesics.