Combined intranasal fentanyl and dexmedetomidine plus inhaled nitrous oxide sedation in children needing myringotomy and ventilation tube insertion with a specific handheld device

Andrea Trombetta, Francesca Cossovel, Domenico Leonardo Grasso, Egidio Barbi

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: We report a case series of one-time 4 mcg/kg dose of intranasal dexmedetomidine and 1 mcg/kg of intranasal fentanyl plus inhaled nitrous oxide for procedural sedation in children with otitis media with effusion (OME) for tympanostomy tube placement with a specific handheld device (Solo TTD, AventaMed ®). Methods: A retrospective review was conducted in a tertiary paediatric teaching hospital on patients with OME referred from December 2018 to December 2019 in need of procedural sedation for myringotomy and ventilation tube insertion (VTI). Sixteen of twenty-four consecutively admitted subjects received a one-time dose (4 mcg/kg) of intranasal dexmedetomidine and 1mcg/Kg of intranasal fentanyl followed by inhaled nitrous oxide (iN2O) at 50% with the intended goal to achieve a Ramsay Sedation Score 4 allowing a motionless procedure with adequate analgesia. Parents’ satisfaction for the procedure was measured by mean of a Likert scale (from 0 to 5 points). Results: Sixteen patients underwent procedural sedation for myringotomy with VTI. Sedation was achieved successfully in fifteen patients (93,75%), with a mean induction time of 29 min (range 19–43) and a mean recovery time of 74 min (range 54–110). The patient who did reach an adequate sedation level underwent an intravenous line positioning and a dose of ketamine. No adverse effects were reported, and the parents’ judgment average on the Likert scale was 4,93. VTI procedure was successful in all ears. Conclusions: A combination of intranasal dexmedetomidine, fentanyl, and iN2O could be considered as a possible option for procedural sedation in children with OME undergoing procedural sedation for tympanostomy tube placement in children with Solo TTD device.

Original languageEnglish
Article number110221
JournalInternational Journal of Pediatric Otorhinolaryngology
Volume136
DOIs
Publication statusPublished - Sep 2020

Keywords

  • intranasal dexmedetomidine
  • intranasal fentanyl
  • Procedural sedation
  • Tympanostomy tube placement

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Otorhinolaryngology

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