Matilda Boa, Gamunu Ratnayake, Katharine Stenlake
Somerset Foundation Trust, Taunton, United Kingdom
Introduction: Intranasal dexmedetomidine (IND) is an alpha-2 receptor agonist with sedative and analgesic effects, commonly used off-label as premedication for paediatric general anaesthetic worldwide. Use of IND has been shown to improve sedation at parent separation, reduce rescue analgesic use and reduce post-operative nausea and vomiting. Current national paediatric premedication guidelines suggest the use of oral benzodiazepines, commonly midazolam, however this is often unsuccessful due to patient refusal or rejection. This service improvement project assessed the extent to which IND as premedication was perceived to improve anaesthetic induction for paediatric day-case surgery.
Methods: A self-administered questionnaire containing 4 multiple-choice questions and free text comments was completed on the day of theatre, by the anaesthetist or nurse. Data was collected over a 7-month period. Thematic and frequency analyses were then performed.
Results: 15 completed questionnaires were returned, of which 93% were completed by the nurse. 100% of respondents felt IND as a pre-medication improved the induction of anaesthesia and 87% would recommend the use of IND again. Two themes were identified in the qualitative responses: ease of administration and variation in response.
Conclusion: Despite the small sample size, results showed an overall positive effect of IND on anaesthetic induction. Ease of administration for younger, neurodivergent or anxious patients was a significant benefit; although, challenges remain with the predictability of response due to variation in onset, duration and depth of sedation. Further research is needed to identify the paediatric population most likely to benefit from IND compared to routine oral premedication.