Dexmedetomidine improves success of paediatric MRI sedation

Objective To improve success rates of children requiring sedation for MRI. Methods Audits of sedation success for children attending planned MRI using three different approaches: (1) National Institute for Health and Care Excellence (NICE) guidance (chloral hydrate if <15 kg and oral midazolam if >= 15 kg), (2) Chloral hydrate for all patients, (3) Chloral hydrate +/- intranasal dexmedetomidine if <15 kg and intranasal dexmedetomidine alone if >= 15kg. Results 74 patients had 85 MRI scan attempts. Overall success rates were significantly higher when using intranasal dexmedetomidine compared with following NICE guidance (81% vs 52% p=0.017). Dexmedetomidine performed better than oral midazolam for the same indication (76% vs 33% p=0.026). The side effect profile for dexmedetomidine was as reported in larger studies. Conclusions Intranasal dexmedetomidine is an effective alternative to oral midazolam for sedation for MRI and as a rescue medication where chloral hydrate has been ineffective.